| Code | Description | Claims | Beneficiaries | Total Paid |
| 0450 |
|
134,937 |
114,163 |
$1.91M |
| 74177 |
|
10,873 |
9,626 |
$1.38M |
| 96374 |
|
32,512 |
25,982 |
$961K |
| 78815 |
|
1,440 |
1,316 |
$767K |
| A0429 |
Bls-emergency |
20,841 |
15,456 |
$727K |
| 80053 |
|
108,738 |
89,972 |
$697K |
| 0241U |
|
12,278 |
10,598 |
$643K |
| 70450 |
|
12,119 |
10,958 |
$567K |
| 96375 |
|
25,552 |
18,516 |
$513K |
| 80307 |
|
13,126 |
10,478 |
$501K |
| 85025 |
|
107,878 |
88,323 |
$487K |
| 93005 |
|
39,877 |
34,674 |
$429K |
| 74176 |
|
6,264 |
5,629 |
$429K |
| 71275 |
|
2,990 |
2,663 |
$369K |
| 96372 |
|
23,313 |
16,585 |
$347K |
| 70553 |
|
1,953 |
1,766 |
$270K |
| 72125 |
|
3,580 |
3,333 |
$256K |
| J9271 |
Inj pembrolizumab |
48 |
38 |
$254K |
| 96361 |
|
19,509 |
14,677 |
$250K |
| 96365 |
|
8,253 |
5,280 |
$249K |
| 76700 |
|
6,117 |
5,631 |
$246K |
| 93976 |
|
3,146 |
2,800 |
$239K |
| 93971 |
|
3,188 |
2,936 |
$215K |
| 87635 |
|
6,019 |
5,256 |
$180K |
| 99199 |
|
3,631 |
3,487 |
$180K |
| 76856 |
|
4,352 |
3,986 |
$179K |
| 71045 |
|
23,504 |
20,838 |
$179K |
| A9552 |
F18 fdg |
1,449 |
1,356 |
$177K |
| 77067 |
|
1,535 |
1,519 |
$177K |
| J7030 |
Normal saline solution infus |
27,637 |
20,197 |
$177K |
| 71046 |
|
13,779 |
12,870 |
$174K |
| 76830 |
|
3,746 |
3,379 |
$172K |
| 93306 |
|
1,675 |
1,509 |
$171K |
| 93970 |
|
1,488 |
1,382 |
$164K |
| 99283 |
|
9,462 |
8,484 |
$153K |
| J3490 |
Drugs unclassified injection |
19,362 |
10,548 |
$152K |
| 84484 |
|
27,805 |
22,970 |
$146K |
| 96360 |
|
5,953 |
4,861 |
$146K |
| 70551 |
|
1,768 |
1,611 |
$145K |
| 87426 |
|
7,410 |
6,041 |
$139K |
| 77066 |
Tomosynthesis, mammo |
1,501 |
1,451 |
$139K |
| G0378 |
Hospital observation per hr |
834 |
783 |
$138K |
| 71260 |
|
2,323 |
2,209 |
$138K |
| Z9725 |
|
3,113 |
3,045 |
$133K |
| 76815 |
|
3,325 |
2,002 |
$126K |
| 97110 |
|
6,475 |
1,805 |
$108K |
| 88307 |
|
986 |
858 |
$100K |
| J2405 |
Ondansetron hcl injection |
25,659 |
19,271 |
$99K |
| J1170 |
Hydromorphone injection |
14,426 |
10,083 |
$95K |
| P9016 |
Rbc leukocytes reduced |
934 |
734 |
$95K |
| 71250 |
|
2,211 |
2,118 |
$93K |
| 76642 |
|
1,861 |
1,620 |
$92K |
| 59025 |
|
5,146 |
2,648 |
$87K |
| 76801 |
|
1,901 |
1,565 |
$87K |
| 83690 |
|
23,901 |
20,082 |
$87K |
| J1815 |
Insulin injection |
2,772 |
1,605 |
$85K |
| 76817 |
|
1,828 |
1,535 |
$84K |
| 72148 |
|
1,162 |
1,059 |
$82K |
| Z7502 |
|
2,399 |
2,266 |
$76K |
| 97139 |
|
3,133 |
443 |
$73K |
| 99284 |
|
8,085 |
7,389 |
$68K |
| J1885 |
Ketorolac tromethamine inj |
15,966 |
12,157 |
$68K |
| 83880 |
|
5,305 |
4,687 |
$66K |
| G0463 |
Hospital outpt clinic visit |
2,955 |
2,553 |
$63K |
| 70549 |
|
372 |
302 |
$61K |
| 88305 |
|
3,609 |
3,284 |
$59K |
| 70496 |
|
406 |
347 |
$58K |
| 76770 |
|
1,788 |
1,651 |
$57K |
| J7120 |
Ringers lactate infusion |
9,451 |
7,825 |
$56K |
| 84703 |
|
22,549 |
19,407 |
$55K |
| 73564 |
|
3,026 |
2,695 |
$52K |
| 96413 |
|
2,851 |
1,723 |
$51K |
| 36430 |
|
1,114 |
788 |
$51K |
| 96366 |
|
3,514 |
1,933 |
$51K |
| J2270 |
Morphine sulfate injection |
8,007 |
6,163 |
$51K |
| 94640 |
|
5,638 |
4,578 |
$50K |
| J7050 |
Normal saline solution infus |
15,444 |
6,909 |
$50K |
| C1769 |
Guide wire |
1,349 |
1,126 |
$50K |
| 70498 |
|
411 |
346 |
$49K |
| 96367 |
|
1,877 |
1,219 |
$48K |
| 73610 |
|
3,246 |
2,993 |
$48K |
| 73630 |
|
3,423 |
3,080 |
$48K |
| 0270 |
|
49,592 |
30,364 |
$47K |
| 73030 |
|
3,248 |
2,969 |
$47K |
| G0279 |
Tomosynthesis, mammo |
1,486 |
1,428 |
$46K |
| 0202U |
|
397 |
370 |
$45K |
| 87651 |
|
2,120 |
1,944 |
$45K |
| 90715 |
|
2,127 |
1,958 |
$44K |
| 99285 |
|
3,509 |
3,300 |
$44K |
| 76705 |
|
1,852 |
1,679 |
$44K |
| J2704 |
Inj, propofol, 10 mg |
6,164 |
5,143 |
$43K |
| U0003 |
Cov-19 amp prb hgh thruput |
1,395 |
1,288 |
$40K |
| 84145 |
|
3,509 |
2,845 |
$40K |
| J0696 |
Ceftriaxone sodium injection |
7,193 |
5,339 |
$39K |
| 88341 |
|
836 |
749 |
$39K |
| 77065 |
Tomosynthesis, mammo |
505 |
458 |
$39K |
| J3010 |
Fentanyl citrate injection |
8,356 |
6,118 |
$38K |
| 81001 |
|
24,128 |
21,064 |
$38K |
| 97750 |
|
1,075 |
611 |
$37K |
| 81025 |
|
2,782 |
2,524 |
$37K |
| J1100 |
Dexamethasone sodium phos |
8,636 |
6,918 |
$36K |
| 73110 |
|
2,446 |
2,269 |
$35K |
| 72100 |
|
2,106 |
1,982 |
$35K |
| 70486 |
|
536 |
496 |
$33K |
| 73130 |
|
2,431 |
2,217 |
$33K |
| J2765 |
Metoclopramide hcl injection |
6,983 |
5,753 |
$32K |
| 87491 |
|
1,415 |
1,266 |
$31K |
| 87591 |
|
1,412 |
1,266 |
$31K |
| 74178 |
|
290 |
275 |
$30K |
| 84443 |
|
3,798 |
3,287 |
$30K |
| 83735 |
|
8,816 |
6,669 |
$29K |
| J2060 |
Lorazepam injection |
7,400 |
5,344 |
$29K |
| 93798 |
|
2,563 |
431 |
$28K |
| 75574 |
|
211 |
200 |
$28K |
| 82962 |
|
12,860 |
6,597 |
$27K |
| J0690 |
Cefazolin sodium injection |
4,550 |
3,459 |
$27K |
| 83605 |
|
5,191 |
4,325 |
$27K |
| 96376 |
|
10,070 |
7,028 |
$27K |
| J1200 |
Diphenhydramine hcl injectio |
7,464 |
5,285 |
$26K |
| 85027 |
|
7,829 |
6,856 |
$25K |
| 87040 |
|
3,514 |
2,814 |
$24K |
| 85379 |
|
4,396 |
3,924 |
$23K |
| 77386 |
|
142 |
14 |
$23K |
| 73502 |
|
1,486 |
1,357 |
$22K |
| C1894 |
Intro/sheath, non-laser |
757 |
687 |
$22K |
| 74174 |
|
102 |
89 |
$21K |
| 77334 |
|
128 |
92 |
$21K |
| 88360 |
|
287 |
248 |
$21K |
| 0160 |
|
2,647 |
1,490 |
$21K |
| 80048 |
|
6,098 |
4,893 |
$20K |
| J1453 |
Fosaprepitant injection |
218 |
143 |
$20K |
| 72141 |
|
278 |
244 |
$20K |
| 70544 |
|
529 |
444 |
$19K |
| 76641 |
|
307 |
268 |
$19K |
| 77063 |
|
457 |
456 |
$19K |
| 77336 |
|
504 |
212 |
$18K |
| 87086 |
|
4,946 |
4,389 |
$18K |
| 73080 |
|
1,227 |
1,143 |
$18K |
| J2250 |
Inj midazolam hydrochloride |
4,853 |
4,248 |
$17K |
| J2930 |
Methylprednisolone injection |
1,961 |
1,650 |
$17K |
| J2710 |
Neostigmine methylslfte inj |
756 |
694 |
$17K |
| 80305 |
|
2,396 |
2,052 |
$16K |
| 87077 |
|
3,545 |
3,188 |
$15K |
| J3370 |
Vancomycin hcl injection |
2,140 |
1,305 |
$15K |
| M0243 |
Casirivi and imdevi inj |
201 |
184 |
$15K |
| 85610 |
|
8,623 |
7,331 |
$15K |
| 0762 |
|
781 |
481 |
$15K |
| 88342 |
|
1,278 |
1,143 |
$14K |
| 84702 |
|
2,465 |
2,003 |
$14K |
| 87502 |
|
534 |
491 |
$14K |
| 76870 |
|
434 |
391 |
$14K |
| J7040 |
Normal saline solution infus |
3,909 |
3,178 |
$13K |
| J1642 |
Inj heparin sodium per 10 u |
3,569 |
1,446 |
$13K |
| 72131 |
|
265 |
230 |
$13K |
| 81003 |
|
12,014 |
10,821 |
$13K |
| L1830 |
Ko immob canvas long pre ots |
219 |
190 |
$13K |
| 77049 |
|
40 |
39 |
$13K |
| 93880 |
|
164 |
153 |
$13K |
| 76536 |
|
468 |
460 |
$13K |
| J2543 |
Piperacillin/tazobactam |
1,031 |
471 |
$12K |
| 0360 |
|
3,536 |
2,755 |
$12K |
| 88304 |
|
872 |
795 |
$12K |
| J0131 |
Inj, acetaminophen (nos) |
711 |
653 |
$12K |
| 73562 |
|
992 |
868 |
$11K |
| 0250 |
|
7,411 |
4,373 |
$11K |
| 80061 |
|
1,568 |
1,462 |
$11K |
| 83036 |
|
1,961 |
1,812 |
$10K |
| 36415 |
|
22,246 |
18,917 |
$10K |
| 87081 |
|
3,617 |
3,249 |
$10K |
| 99281 |
|
516 |
450 |
$10K |
| 87186 |
|
2,568 |
2,288 |
$10K |
| 96417 |
|
336 |
210 |
$10K |
| J1650 |
Inj enoxaparin sodium |
1,716 |
1,101 |
$10K |
| 73140 |
|
1,253 |
1,203 |
$10K |
| 70491 |
|
99 |
80 |
$9K |
| 12001 |
|
1,275 |
1,219 |
$9K |
| 99070 |
|
1,244 |
773 |
$9K |
| 86923 |
|
652 |
561 |
$9K |
| 74018 |
|
952 |
883 |
$9K |
| J0780 |
Prochlorperazine injection |
869 |
672 |
$9K |
| 99282 |
|
657 |
618 |
$9K |
| 97162 |
|
785 |
764 |
$8K |
| Z7610 |
|
577 |
432 |
$8K |
| 10060 |
|
871 |
803 |
$8K |
| 97140 |
|
1,249 |
414 |
$8K |
| 85730 |
|
3,196 |
2,833 |
$7K |
| J0330 |
Succinycholine chloride inj |
615 |
557 |
$7K |
| C9803 |
Hopd covid-19 spec collect |
995 |
950 |
$7K |
| 93010 |
|
2,563 |
2,216 |
$7K |
| 12011 |
|
772 |
738 |
$7K |
| 87633 |
|
42 |
41 |
$6K |
| 73590 |
|
491 |
447 |
$6K |
| 87880 |
|
1,875 |
1,769 |
$6K |
| 96415 |
|
171 |
101 |
$6K |
| 77300 |
|
77 |
65 |
$6K |
| M0222 |
Bebtelovimab injection |
55 |
52 |
$6K |
| C1887 |
Catheter, guiding |
149 |
141 |
$6K |
| 86140 |
|
2,218 |
1,846 |
$6K |
| A9270 |
Non-covered item or service |
11,922 |
4,013 |
$6K |
| 87070 |
|
1,648 |
1,485 |
$5K |
| 86901 |
|
4,192 |
3,641 |
$5K |
| 99499 |
|
112 |
97 |
$5K |
| J1644 |
Inj heparin sodium per 1000u |
1,555 |
884 |
$5K |
| 90471 |
|
1,860 |
1,700 |
$5K |
| 86900 |
|
4,199 |
3,642 |
$5K |
| S0164 |
Injection pantroprazole |
516 |
311 |
$5K |
| J0585 |
Injection,onabotulinumtoxina |
23 |
13 |
$5K |
| 82550 |
|
1,230 |
995 |
$4K |
| 73090 |
|
400 |
366 |
$4K |
| 72072 |
|
231 |
223 |
$4K |
| 77080 |
|
153 |
148 |
$4K |
| 78452 |
|
32 |
27 |
$4K |
| 82805 |
|
304 |
267 |
$4K |
| J3486 |
Ziprasidone mesylate |
138 |
104 |
$4K |
| L4386 |
Non-pneum walk boot pre cst |
70 |
64 |
$3K |
| 84439 |
|
798 |
685 |
$3K |
| A4648 |
Implantable tissue marker |
166 |
138 |
$3K |
| 97112 |
|
1,355 |
448 |
$3K |
| 43239 |
|
174 |
160 |
$3K |
| J2370 |
Phenylephrine hcl injection |
415 |
379 |
$3K |
| 0370 |
|
3,243 |
3,086 |
$3K |
| 87205 |
|
1,862 |
1,649 |
$3K |
| 86850 |
|
2,763 |
2,378 |
$3K |
| V5008 |
Hearing screening |
115 |
109 |
$3K |
| 87389 |
|
190 |
167 |
$3K |
| 86304 |
|
492 |
358 |
$3K |
| J0134 |
Inj acetaminophen -fresenius |
223 |
196 |
$3K |
| M0239 |
Bamlanivimab-xxxx infusion |
31 |
22 |
$3K |
| 72040 |
|
153 |
140 |
$3K |
| 85652 |
|
1,659 |
1,388 |
$2K |
| 86308 |
|
836 |
755 |
$2K |
| J3475 |
Inj magnesium sulfate |
953 |
448 |
$2K |
| 97530 |
|
1,075 |
705 |
$2K |
| 82077 |
|
273 |
141 |
$2K |
| J1940 |
Furosemide injection |
626 |
466 |
$2K |
| J8540 |
Oral dexamethasone |
267 |
220 |
$2K |
| A9500 |
Tc99m sestamibi |
46 |
39 |
$2K |
| 73700 |
|
28 |
25 |
$2K |
| 85046 |
|
785 |
713 |
$2K |
| M0247 |
Sotrovimab infusion |
20 |
18 |
$2K |
| Q9957 |
Inj perflutren lip micros,ml |
68 |
53 |
$2K |
| J0360 |
Hydralazine hcl injection |
345 |
257 |
$2K |
| 0272 |
|
2,266 |
2,118 |
$2K |
| J0153 |
Adenosine inj 1mg |
72 |
65 |
$2K |
| J7512 |
Prednisone ir or dr oral 1mg |
1,378 |
948 |
$2K |
| J1230 |
Methadone injection |
115 |
109 |
$2K |
| 82570 |
|
494 |
419 |
$1K |
| 71270 |
|
25 |
25 |
$1K |
| 12002 |
|
159 |
155 |
$1K |
| J1626 |
Granisetron hcl injection |
276 |
136 |
$1K |
| 72128 |
|
14 |
12 |
$1K |
| 73660 |
|
153 |
145 |
$1K |
| 0710 |
|
3,025 |
2,714 |
$1K |
| 86922 |
|
78 |
62 |
$1K |
| 83615 |
|
424 |
327 |
$1K |
| 72110 |
|
54 |
53 |
$1K |
| 36569 |
|
36 |
36 |
$1K |
| 84100 |
|
471 |
346 |
$1K |
| 11042 |
|
878 |
418 |
$1K |
| 29125 |
|
389 |
363 |
$1K |
| 71010 |
|
250 |
245 |
$1K |
| J1171 |
Inj, hydromorphone, 0.1 mg |
153 |
112 |
$1K |
| J2800 |
Methocarbamol injection |
132 |
118 |
$1K |
| G0480 |
Drug test def 1-7 classes |
146 |
127 |
$1K |
| 83550 |
|
339 |
299 |
$1K |
| 82728 |
|
267 |
222 |
$974.82 |
| C1729 |
Cath, drainage |
12 |
12 |
$957.17 |
| 88112 |
|
65 |
53 |
$955.44 |
| 82378 |
|
189 |
140 |
$907.01 |
| 86780 |
|
89 |
77 |
$896.89 |
| J3480 |
Inj potassium chloride |
292 |
200 |
$870.32 |
| 93017 |
|
29 |
24 |
$855.98 |
| 83540 |
|
342 |
301 |
$854.09 |
| 88173 |
|
26 |
25 |
$842.68 |
| J1836 |
Inj, metronidazole, 10 mg |
203 |
147 |
$831.91 |
| 97116 |
|
420 |
264 |
$820.35 |
| J2919 |
Inj, methylpred sod succ 5mg |
82 |
73 |
$801.73 |
| 87088 |
|
393 |
366 |
$759.25 |
| J1953 |
Levetiracetam injection |
56 |
36 |
$755.08 |
| 76819 |
|
13 |
12 |
$739.46 |
| C9113 |
Inj pantoprazole sodium, via |
162 |
132 |
$727.56 |
| 88331 |
|
25 |
24 |
$678.42 |
| 73060 |
|
57 |
52 |
$605.76 |
| 87486 |
|
42 |
41 |
$588.49 |
| 87581 |
|
42 |
41 |
$588.49 |
| 84550 |
|
289 |
247 |
$587.20 |
| 76882 |
|
16 |
13 |
$482.97 |
| 86803 |
|
38 |
38 |
$475.20 |
| G1004 |
Cdsm ndsc |
24,553 |
17,560 |
$469.04 |
| 0636 |
|
1,146 |
449 |
$453.07 |
| 85007 |
|
324 |
316 |
$417.38 |
| A9541 |
Tc99m sulfur colloid |
12 |
12 |
$417.06 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
137 |
116 |
$409.96 |
| 0760 |
|
605 |
512 |
$385.92 |
| 80179 |
|
43 |
29 |
$380.24 |
| J9045 |
Carboplatin injection |
16 |
12 |
$364.05 |
| 82306 |
|
40 |
36 |
$355.97 |
| A4217 |
Sterile water/saline, 500 ml |
84 |
64 |
$352.14 |
| Q3014 |
Telehealth facility fee |
99 |
96 |
$342.81 |
| 87798 |
|
59 |
53 |
$324.92 |
| 88172 |
|
25 |
24 |
$260.27 |
| 73552 |
|
24 |
24 |
$259.42 |
| 84156 |
|
115 |
94 |
$253.23 |
| 80320 |
|
388 |
338 |
$249.23 |
| 87075 |
|
71 |
62 |
$246.07 |
| 0271 |
|
206 |
164 |
$236.49 |
| J1630 |
Haloperidol injection |
340 |
263 |
$230.53 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
42 |
36 |
$229.23 |
| 99291 |
|
12 |
12 |
$216.64 |
| 80143 |
|
44 |
29 |
$212.05 |
| 72170 |
|
25 |
25 |
$210.77 |
| 76942 |
|
13 |
13 |
$206.07 |
| 87340 |
|
32 |
28 |
$200.70 |
| 29515 |
|
56 |
52 |
$200.14 |
| 36591 |
|
64 |
49 |
$196.28 |
| 76098 |
|
13 |
13 |
$187.27 |
| J1810 |
Droperidol/fentanyl inj |
166 |
148 |
$186.10 |
| 82607 |
|
55 |
51 |
$184.39 |
| 81002 |
|
338 |
318 |
$168.99 |
| J2469 |
Palonosetron hcl |
16 |
12 |
$162.77 |
| J3411 |
Thiamine hcl 100 mg |
35 |
17 |
$149.75 |
| J2470 |
Inj pantoprazole sodium 40mg |
36 |
29 |
$148.17 |
| 87210 |
|
57 |
50 |
$146.71 |
| J0456 |
Azithromycin |
23 |
12 |
$144.33 |
| 86592 |
|
30 |
26 |
$105.09 |
| J7060 |
5% dextrose/water |
26 |
12 |
$92.57 |
| 82043 |
|
13 |
13 |
$78.21 |
| 82248 |
|
18 |
15 |
$65.54 |
| 36600 |
|
57 |
52 |
$60.55 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
12 |
12 |
$55.18 |
| 99153 |
Mod sedat endo service >5yrs |
14 |
12 |
$44.72 |
| 85045 |
|
44 |
43 |
$37.23 |
| 83935 |
|
12 |
12 |
$36.15 |
| 99152 |
|
15 |
15 |
$35.78 |
| 84300 |
|
12 |
12 |
$26.35 |
| 89051 |
|
12 |
12 |
$25.08 |
| 29130 |
|
12 |
12 |
$16.80 |
| Q0162 |
Ondansetron oral |
87 |
77 |
$13.94 |
| 82272 |
|
16 |
14 |
$12.21 |
| 87420 |
|
18 |
14 |
$9.33 |
| J1956 |
Levofloxacin injection |
12 |
12 |
$1.58 |
| 0637 |
|
280 |
211 |
$0.43 |
| 0390 |
|
18 |
13 |
$0.00 |
| G8979 |
Mobility goal status |
226 |
217 |
$0.00 |
| 0412 |
|
18 |
17 |
$0.00 |
| 0351 |
|
142 |
113 |
$0.00 |
| 0320 |
|
353 |
252 |
$0.00 |
| 0480 |
|
32 |
26 |
$0.00 |
| 0921 |
|
79 |
74 |
$0.00 |
| 0300 |
|
1,525 |
579 |
$0.00 |
| G8978 |
Mobility current status |
197 |
192 |
$0.00 |
| 80301 |
|
192 |
183 |
$0.00 |
| 0278 |
|
14 |
14 |
$0.00 |
| 0402 |
|
358 |
250 |
$0.00 |
| 0403 |
|
35 |
23 |
$0.00 |
| C8929 |
Tte w or wo fol wcon,doppler |
13 |
13 |
$0.00 |
| 0750 |
|
19 |
13 |
$0.00 |
| 84112 |
|
54 |
49 |
$0.00 |
| 0260 |
|
241 |
50 |
$0.00 |
| 0510 |
|
78 |
64 |
$0.00 |
| 0940 |
|
74 |
33 |
$0.00 |
| 0302 |
|
88 |
53 |
$0.00 |
| 0361 |
|
26 |
19 |
$0.00 |
| 0343 |
|
27 |
26 |
$0.00 |
| J7510 |
Prednisolone oral per 5 mg |
12 |
12 |
$0.00 |
| 94729 |
|
12 |
12 |
$0.00 |
| 0324 |
|
337 |
322 |
$0.00 |
| 0612 |
Calcium glucon (wg critical) |
33 |
23 |
$0.00 |
| 0761 |
|
69 |
57 |
$0.00 |
| 0352 |
|
137 |
107 |
$0.00 |
| 0401 |
|
41 |
25 |
$0.00 |
| 59050 |
|
77 |
69 |
$0.00 |
| 0301 |
|
1,667 |
799 |
$0.00 |
| 0306 |
|
297 |
221 |
$0.00 |
| 80329 |
|
185 |
178 |
$0.00 |
| 0350 |
|
246 |
200 |
$0.00 |
| 0335 |
|
97 |
30 |
$0.00 |
| 0258 |
|
178 |
74 |
$0.00 |
| G8980 |
Mobility d/c status |
13 |
12 |
$0.00 |
| 0610 |
|
21 |
20 |
$0.00 |
| 27502 |
|
13 |
13 |
$0.00 |
| 0305 |
|
636 |
474 |
$0.00 |
| 27610 |
|
16 |
14 |
$0.00 |
| 0307 |
|
103 |
97 |
$0.00 |
| 0404 |
|
22 |
16 |
$0.00 |
| Q4051 |
Splint supplies misc |
63 |
17 |
$0.00 |
| 0310 |
|
68 |
39 |
$0.00 |
| 0611 |
|
33 |
28 |
$0.00 |