| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
|
888,043 |
795,096 |
$44.62M |
| 99214 |
|
645,447 |
575,444 |
$42.59M |
| 99232 |
|
357,933 |
141,279 |
$13.40M |
| 99391 |
|
85,174 |
69,963 |
$6.94M |
| 99392 |
|
67,850 |
60,874 |
$5.93M |
| 99223 |
Prolong inpt eval add15 m |
53,646 |
48,044 |
$5.51M |
| 99203 |
|
80,173 |
73,921 |
$5.08M |
| 99204 |
|
58,507 |
54,024 |
$5.07M |
| 59426 |
|
71,730 |
43,977 |
$4.95M |
| 59425 |
|
55,376 |
44,043 |
$3.48M |
| 99233 |
Prolong inpt eval add15 m |
69,250 |
34,055 |
$3.13M |
| 99222 |
|
36,333 |
31,899 |
$2.66M |
| 87426 |
|
77,344 |
72,484 |
$2.57M |
| 90471 |
|
216,101 |
191,101 |
$2.34M |
| 99393 |
|
26,820 |
24,997 |
$2.34M |
| 99239 |
|
41,258 |
36,775 |
$2.10M |
| 99238 |
|
44,188 |
39,740 |
$2.01M |
| 90472 |
|
103,370 |
90,627 |
$1.95M |
| 99215 |
Prolong outpt/office vis |
19,183 |
17,199 |
$1.55M |
| 76816 |
|
20,015 |
16,648 |
$1.45M |
| 93306 |
|
39,440 |
36,942 |
$1.34M |
| 87428 |
|
39,557 |
37,332 |
$1.20M |
| 99212 |
|
37,168 |
32,842 |
$1.12M |
| 01967 |
|
6,725 |
5,704 |
$1.11M |
| 76811 |
|
7,584 |
6,883 |
$901K |
| 43239 |
|
9,080 |
8,511 |
$770K |
| 99460 |
|
11,584 |
10,471 |
$722K |
| 11042 |
|
21,318 |
10,361 |
$709K |
| 99231 |
|
32,991 |
16,820 |
$678K |
| 99309 |
|
27,354 |
22,426 |
$559K |
| 90834 |
|
11,579 |
7,935 |
$558K |
| 99221 |
|
10,495 |
9,567 |
$555K |
| 99291 |
|
5,614 |
2,060 |
$538K |
| 99394 |
|
6,160 |
5,614 |
$510K |
| G2066 |
Inter devc remote 30d |
6,759 |
6,224 |
$499K |
| 59409 |
|
1,959 |
1,666 |
$456K |
| 76819 |
|
7,859 |
4,377 |
$448K |
| 59430 |
|
5,668 |
4,052 |
$424K |
| 87804 |
|
32,389 |
15,022 |
$405K |
| 87430 |
|
33,058 |
31,031 |
$394K |
| 81002 |
|
150,804 |
102,362 |
$380K |
| 99202 |
|
9,276 |
8,534 |
$373K |
| 87880 |
|
29,310 |
26,658 |
$330K |
| 90474 |
|
26,488 |
22,879 |
$316K |
| 87635 |
|
7,999 |
7,357 |
$312K |
| 76805 |
|
4,450 |
4,059 |
$279K |
| 20610 |
|
9,778 |
8,536 |
$277K |
| 90791 |
|
3,897 |
3,487 |
$267K |
| 76830 |
|
4,397 |
4,036 |
$246K |
| 99205 |
Prolong outpt/office vis |
3,214 |
2,981 |
$246K |
| 99395 |
|
6,186 |
5,768 |
$245K |
| 93010 |
|
66,251 |
49,730 |
$230K |
| 76817 |
|
4,713 |
3,826 |
$205K |
| 54150 |
|
2,239 |
1,826 |
$190K |
| 95165 |
|
1,264 |
1,181 |
$165K |
| 99211 |
|
11,791 |
10,859 |
$161K |
| 90686 |
|
74,719 |
66,329 |
$156K |
| 96110 |
|
19,200 |
16,222 |
$156K |
| 76820 |
|
5,072 |
2,904 |
$155K |
| 96156 |
|
2,057 |
1,912 |
$154K |
| 43644 |
|
126 |
112 |
$153K |
| 99308 |
|
11,630 |
9,146 |
$151K |
| 59025 |
|
6,620 |
4,000 |
$146K |
| 45385 |
|
1,242 |
1,157 |
$142K |
| 99152 |
|
16,884 |
15,049 |
$140K |
| 95810 |
|
1,666 |
1,606 |
$136K |
| 93295 |
|
6,875 |
6,287 |
$135K |
| 76815 |
|
3,351 |
2,511 |
$133K |
| 11721 |
|
10,661 |
9,131 |
$133K |
| 93000 |
|
19,053 |
17,495 |
$131K |
| 71046 |
|
6,205 |
5,804 |
$126K |
| 90837 |
|
2,016 |
1,230 |
$123K |
| 64493 |
|
1,676 |
1,388 |
$123K |
| 93297 |
|
14,231 |
13,055 |
$122K |
| 77427 |
|
1,485 |
713 |
$118K |
| 73630 |
|
6,128 |
5,058 |
$115K |
| 99462 |
|
4,272 |
2,983 |
$115K |
| S2083 |
Adjustment gastric band |
246 |
229 |
$113K |
| 97802 |
|
1,912 |
1,676 |
$106K |
| 93299 |
|
2,286 |
2,063 |
$103K |
| 93923 |
|
3,511 |
3,192 |
$101K |
| 93296 |
|
14,007 |
12,826 |
$96K |
| 99354 |
|
3,432 |
2,793 |
$91K |
| 80305 |
|
10,017 |
7,446 |
$89K |
| 99396 |
|
3,632 |
3,387 |
$86K |
| 83655 |
|
12,519 |
10,831 |
$82K |
| 64483 |
|
999 |
892 |
$82K |
| 99480 |
|
1,281 |
394 |
$80K |
| 45380 |
|
1,103 |
1,009 |
$79K |
| 99305 |
|
1,857 |
1,584 |
$79K |
| 83036 |
|
17,700 |
15,841 |
$77K |
| 92557 |
|
3,709 |
3,465 |
$77K |
| 95806 |
|
2,128 |
1,993 |
$73K |
| 73610 |
|
3,724 |
3,233 |
$72K |
| 99219 |
|
1,723 |
1,553 |
$69K |
| 92567 |
|
9,667 |
8,970 |
$69K |
| 78452 |
|
2,283 |
2,158 |
$67K |
| J1050 |
Medroxyprogesterone acetate |
2,200 |
1,971 |
$66K |
| 77014 |
|
3,079 |
580 |
$66K |
| 64494 |
|
1,664 |
1,337 |
$64K |
| 90792 |
|
652 |
587 |
$59K |
| 99479 |
|
928 |
248 |
$58K |
| 99306 |
Prolong nursin fac eval 15m |
1,151 |
979 |
$56K |
| 99217 |
|
2,777 |
2,531 |
$55K |
| 59514 |
|
685 |
585 |
$54K |
| 97803 |
|
1,586 |
1,368 |
$53K |
| 43235 |
|
731 |
662 |
$50K |
| 93016 |
|
4,984 |
4,703 |
$49K |
| 99385 |
|
1,377 |
1,274 |
$49K |
| 87400 |
|
5,018 |
2,344 |
$49K |
| G9997 |
Doc pt preg dur msrmt pd |
1,042 |
821 |
$48K |
| 95117 |
|
7,718 |
4,127 |
$47K |
| 90674 |
|
3,214 |
2,882 |
$45K |
| 73110 |
|
2,124 |
1,751 |
$45K |
| 96127 |
|
10,732 |
8,293 |
$44K |
| 90832 |
|
1,143 |
866 |
$43K |
| 99177 |
|
12,218 |
11,430 |
$42K |
| 81003 |
|
27,017 |
22,527 |
$42K |
| 93294 |
|
4,730 |
4,257 |
$41K |
| 73130 |
|
2,135 |
1,845 |
$40K |
| 99220 |
|
1,012 |
928 |
$38K |
| 90853 |
|
2,133 |
1,532 |
$37K |
| J3301 |
Triamcinolone acet inj nos |
6,913 |
6,211 |
$36K |
| 93922 |
|
1,749 |
1,531 |
$36K |
| 73564 |
|
1,864 |
1,343 |
$36K |
| 95251 |
|
2,003 |
1,795 |
$35K |
| 94060 |
|
4,625 |
4,329 |
$35K |
| 90671 |
|
7,049 |
6,422 |
$33K |
| 95886 |
|
490 |
449 |
$32K |
| 93018 |
|
4,958 |
4,678 |
$32K |
| 94729 |
|
4,833 |
4,555 |
$32K |
| 81025 |
|
7,829 |
6,825 |
$29K |
| 96372 |
|
4,731 |
3,831 |
$29K |
| 99235 |
|
319 |
299 |
$29K |
| 85018 |
|
13,134 |
11,357 |
$29K |
| 76821 |
|
903 |
322 |
$26K |
| 72100 |
|
1,728 |
1,607 |
$26K |
| 95811 |
|
432 |
412 |
$26K |
| 76801 |
|
835 |
757 |
$25K |
| 92551 |
|
5,775 |
5,052 |
$25K |
| 99349 |
|
804 |
681 |
$25K |
| 99310 |
Prolong nursin fac eval 15m |
501 |
447 |
$23K |
| 99383 |
|
284 |
251 |
$23K |
| 77334 |
|
424 |
261 |
$23K |
| 90670 |
|
39,839 |
33,265 |
$23K |
| 96150 |
|
502 |
398 |
$22K |
| 97110 |
|
872 |
344 |
$22K |
| 91322 |
|
433 |
365 |
$20K |
| J0702 |
Betamethasone acet&sod phosp |
2,795 |
2,558 |
$20K |
| 97597 |
|
1,289 |
791 |
$20K |
| 90715 |
|
3,267 |
2,816 |
$19K |
| 30520 |
|
43 |
42 |
$19K |
| 93880 |
|
469 |
395 |
$18K |
| 20611 |
|
339 |
296 |
$18K |
| 90716 |
|
2,014 |
1,656 |
$18K |
| 90480 |
|
1,731 |
1,021 |
$18K |
| 93970 |
|
465 |
425 |
$17K |
| 96040 |
|
607 |
532 |
$17K |
| 99406 |
|
2,553 |
2,291 |
$16K |
| 0072A |
|
478 |
446 |
$16K |
| 77300 |
|
329 |
275 |
$15K |
| 0071A |
|
471 |
441 |
$15K |
| 95782 |
|
152 |
149 |
$15K |
| J7307 |
Etonogestrel implant system |
269 |
234 |
$15K |
| 91321 |
|
399 |
272 |
$14K |
| 90651 |
|
1,940 |
1,729 |
$14K |
| 99386 |
|
566 |
529 |
$14K |
| 92579 |
|
392 |
371 |
$13K |
| G6002 |
Stereoscopic x-ray guidance |
1,326 |
297 |
$13K |
| 11045 |
|
470 |
277 |
$13K |
| 31237 |
|
77 |
55 |
$13K |
| J1030 |
Methylprednisolone 40 mg inj |
2,128 |
1,909 |
$13K |
| 11056 |
|
606 |
528 |
$12K |
| 99335 |
|
712 |
578 |
$12K |
| 73030 |
|
1,038 |
937 |
$12K |
| 99315 |
|
360 |
315 |
$12K |
| 29848 |
|
44 |
40 |
$12K |
| 69436 |
|
81 |
80 |
$12K |
| 46600 |
|
222 |
210 |
$11K |
| J7298 |
Mirena, 52 mg |
372 |
332 |
$11K |
| 93971 |
|
974 |
890 |
$11K |
| 99421 |
|
3,831 |
3,464 |
$10K |
| 99174 |
|
2,874 |
2,230 |
$10K |
| 96167 |
|
322 |
154 |
$10K |
| 73562 |
|
887 |
686 |
$10K |
| 80061 |
|
1,445 |
1,211 |
$9K |
| 94640 |
|
1,729 |
1,518 |
$9K |
| 94726 |
|
1,797 |
1,691 |
$9K |
| 0124A |
|
632 |
425 |
$9K |
| 90732 |
|
772 |
723 |
$9K |
| 99469 |
|
37 |
27 |
$8K |
| 90460 |
|
7,190 |
2,643 |
$8K |
| 99422 |
|
1,136 |
1,041 |
$8K |
| 99459 |
|
490 |
460 |
$8K |
| 64635 |
|
37 |
34 |
$8K |
| 64490 |
|
71 |
65 |
$7K |
| 90739 |
|
80 |
72 |
$7K |
| 90833 |
|
157 |
80 |
$7K |
| J1040 |
Methylprednisolone 80 mg inj |
1,178 |
1,084 |
$7K |
| 30140 |
|
55 |
54 |
$7K |
| 31575 |
|
290 |
272 |
$7K |
| 99173 |
|
6,195 |
5,409 |
$7K |
| 90461 |
|
4,119 |
1,481 |
$6K |
| 99225 |
|
1,095 |
661 |
$6K |
| 96154 |
|
222 |
145 |
$6K |
| 76825 |
|
60 |
53 |
$6K |
| 99381 |
|
263 |
226 |
$6K |
| 90698 |
|
27,190 |
23,046 |
$6K |
| 36416 |
|
3,924 |
3,050 |
$5K |
| 87420 |
|
756 |
701 |
$5K |
| 73502 |
|
458 |
412 |
$5K |
| 93458 |
|
315 |
285 |
$5K |
| 76813 |
|
127 |
110 |
$5K |
| 90680 |
|
29,493 |
24,541 |
$5K |
| 99348 |
|
266 |
219 |
$5K |
| 20550 |
|
314 |
281 |
$5K |
| 31231 |
|
123 |
109 |
$5K |
| 0081A |
|
135 |
132 |
$5K |
| 99307 |
|
632 |
522 |
$5K |
| 76818 |
|
641 |
347 |
$4K |
| 97112 |
|
101 |
54 |
$4K |
| 77263 |
|
87 |
83 |
$4K |
| 97039 |
|
519 |
390 |
$4K |
| 87807 |
|
502 |
443 |
$4K |
| 99382 |
|
44 |
25 |
$4K |
| 64491 |
|
71 |
64 |
$4K |
| 90713 |
|
190 |
178 |
$4K |
| 76981 |
|
84 |
78 |
$4K |
| 69210 |
|
394 |
343 |
$4K |
| 96161 |
|
2,258 |
1,769 |
$4K |
| 77301 |
|
14 |
13 |
$4K |
| 43770 |
|
17 |
15 |
$3K |
| 64636 |
|
37 |
34 |
$3K |
| 86580 |
|
964 |
821 |
$3K |
| 0154A |
|
84 |
80 |
$3K |
| 64495 |
|
117 |
90 |
$3K |
| 73140 |
|
287 |
230 |
$3K |
| 64484 |
|
96 |
84 |
$3K |
| 93793 |
|
574 |
301 |
$3K |
| 36415 |
|
1,812 |
1,467 |
$3K |
| 90661 |
|
375 |
353 |
$3K |
| 96381 |
|
240 |
171 |
$3K |
| 45378 |
|
426 |
417 |
$3K |
| 01961 |
|
378 |
355 |
$2K |
| 94727 |
|
105 |
98 |
$2K |
| 77338 |
|
15 |
14 |
$2K |
| 87502 |
|
85 |
75 |
$2K |
| 99442 |
|
246 |
233 |
$2K |
| 90677 |
|
6,595 |
5,946 |
$2K |
| 95910 |
|
12 |
12 |
$2K |
| 58661 |
|
39 |
31 |
$2K |
| 91200 |
|
138 |
122 |
$2K |
| 45330 |
|
29 |
26 |
$2K |
| 85610 |
|
847 |
449 |
$2K |
| 00170 |
|
15 |
15 |
$2K |
| 96168 |
|
106 |
52 |
$2K |
| 93280 |
|
83 |
75 |
$2K |
| 99384 |
|
13 |
13 |
$2K |
| 94664 |
|
149 |
133 |
$2K |
| 93244 |
|
111 |
98 |
$2K |
| J1010 |
Inj, methylpred acetate 1 mg |
332 |
245 |
$1K |
| 90710 |
|
3,630 |
3,173 |
$1K |
| 73080 |
|
112 |
98 |
$1K |
| 11750 |
|
21 |
12 |
$1K |
| 90621 |
|
55 |
41 |
$1K |
| 99443 |
|
109 |
104 |
$1K |
| 47562 |
|
223 |
194 |
$1K |
| 0054A |
|
80 |
76 |
$1K |
| 76827 |
|
73 |
65 |
$1K |
| 95800 |
|
344 |
317 |
$1K |
| 72110 |
|
180 |
173 |
$1K |
| 99336 |
|
110 |
101 |
$1K |
| 90691 |
|
13 |
13 |
$1K |
| 92504 |
|
92 |
57 |
$1K |
| 11981 |
|
232 |
203 |
$1K |
| 97140 |
|
48 |
25 |
$1K |
| 58670 |
|
124 |
105 |
$1K |
| 0173A |
|
30 |
27 |
$1K |
| 95012 |
|
150 |
135 |
$1K |
| 72040 |
|
327 |
310 |
$990.85 |
| 43450 |
|
41 |
39 |
$976.98 |
| 95909 |
|
12 |
12 |
$968.28 |
| 97810 |
|
657 |
511 |
$954.02 |
| 98925 |
|
82 |
64 |
$936.87 |
| 58300 |
|
511 |
442 |
$839.79 |
| 0082A |
|
36 |
26 |
$811.80 |
| 0003A |
|
67 |
67 |
$781.41 |
| 99417 |
Prolong home eval add 15m |
18 |
15 |
$728.24 |
| 11055 |
|
33 |
26 |
$727.98 |
| 76536 |
|
15 |
12 |
$683.07 |
| 99350 |
Prolong home eval add 15m |
37 |
28 |
$680.22 |
| 90656 |
|
1,811 |
1,752 |
$650.10 |
| 93325 |
|
494 |
441 |
$646.10 |
| 93040 |
|
115 |
105 |
$612.76 |
| 11976 |
|
182 |
168 |
$585.50 |
| 57454 |
|
184 |
167 |
$584.63 |
| 99201 |
|
101 |
83 |
$584.37 |
| 92588 |
|
24 |
24 |
$584.00 |
| 93227 |
|
333 |
323 |
$576.54 |
| 90633 |
|
15,373 |
13,042 |
$550.32 |
| 90662 |
|
85 |
79 |
$541.74 |
| G2012 |
Brief check in by md/qhp |
297 |
269 |
$533.86 |
| 93248 |
|
27 |
24 |
$531.09 |
| 90744 |
|
9,373 |
7,838 |
$525.48 |
| 20600 |
|
34 |
26 |
$519.37 |
| 93990 |
|
15 |
12 |
$489.20 |
| 92978 |
|
13 |
12 |
$475.09 |
| 86308 |
|
409 |
376 |
$459.18 |
| 99497 |
|
130 |
102 |
$455.24 |
| 98926 |
|
21 |
20 |
$436.53 |
| 92587 |
|
29 |
28 |
$434.01 |
| G0444 |
Depression screen annual |
77 |
56 |
$434.01 |
| 99441 |
|
43 |
39 |
$387.91 |
| 90473 |
|
66 |
61 |
$339.00 |
| 73560 |
|
198 |
158 |
$331.95 |
| 94010 |
|
70 |
62 |
$327.69 |
| 58301 |
|
330 |
306 |
$325.18 |
| 93272 |
|
172 |
164 |
$323.34 |
| 58100 |
|
175 |
164 |
$315.72 |
| 90734 |
|
628 |
561 |
$307.50 |
| 99224 |
|
168 |
91 |
$298.47 |
| 62323 |
|
40 |
40 |
$295.79 |
| 0083A |
|
13 |
12 |
$295.20 |
| 99401 |
|
58 |
29 |
$290.26 |
| 90697 |
|
10,244 |
8,698 |
$273.45 |
| J3420 |
Vitamin b12 injection |
344 |
324 |
$258.59 |
| 58611 |
|
116 |
97 |
$244.44 |
| 82247 |
|
69 |
54 |
$226.45 |
| 90694 |
|
14 |
14 |
$216.74 |
| 99226 |
|
188 |
159 |
$215.07 |
| J1885 |
Ketorolac tromethamine inj |
858 |
774 |
$206.49 |
| 90707 |
|
1,807 |
1,414 |
$206.19 |
| 93351 |
|
220 |
204 |
$201.44 |
| J0696 |
Ceftriaxone sodium injection |
688 |
639 |
$192.93 |
| 00790 |
|
15 |
13 |
$178.86 |
| 99234 |
|
27 |
27 |
$178.47 |
| 36556 |
|
18 |
16 |
$167.00 |
| 31500 |
|
51 |
38 |
$162.36 |
| 90696 |
|
1,283 |
1,155 |
$158.40 |
| 93228 |
|
13 |
12 |
$143.49 |
| 82044 |
|
247 |
215 |
$139.53 |
| 93320 |
|
363 |
327 |
$134.20 |
| 73090 |
|
16 |
12 |
$132.54 |
| 10060 |
|
129 |
114 |
$127.35 |
| 82570 |
|
221 |
189 |
$108.16 |
| J1100 |
Dexamethasone sodium phos |
346 |
289 |
$103.44 |
| 87210 |
|
571 |
468 |
$97.86 |
| 58571 |
|
16 |
12 |
$91.37 |
| 82962 |
|
370 |
307 |
$79.48 |
| 17110 |
|
74 |
70 |
$76.36 |
| 20526 |
|
13 |
12 |
$54.16 |
| G2211 |
Complex e/m visit add on |
707 |
592 |
$50.23 |
| G2212 |
Prolong outpt/office vis |
15 |
15 |
$47.83 |
| J7620 |
Albuterol ipratrop non-comp |
685 |
617 |
$43.18 |
| 20605 |
|
72 |
64 |
$35.69 |
| 74018 |
|
25 |
25 |
$33.76 |
| 90672 |
|
56 |
52 |
$27.79 |
| J2791 |
Rhophylac injection |
276 |
191 |
$25.00 |
| 82274 |
|
90 |
82 |
$24.52 |
| J7030 |
Normal saline solution infus |
17 |
17 |
$23.84 |
| J7613 |
Albuterol non-comp unit |
458 |
404 |
$23.37 |
| G8473 |
Ace/arb thxpy rx'd |
28,070 |
14,811 |
$13.98 |
| J7614 |
Levalbuterol non-comp unit |
28 |
27 |
$1.50 |
| 90723 |
|
1,886 |
1,376 |
$0.00 |
| G0008 |
Admin influenza virus vac |
1,263 |
1,207 |
$0.00 |
| 1111F |
|
186 |
181 |
$0.00 |
| 90619 |
|
467 |
414 |
$0.00 |
| 92558 |
|
58 |
57 |
$0.00 |
| G0439 |
Ppps, subseq visit |
126 |
121 |
$0.00 |
| 90620 |
|
287 |
272 |
$0.00 |
| G0180 |
Md certification hha patient |
103 |
87 |
$0.00 |
| 90632 |
|
31 |
28 |
$0.00 |
| 64721 |
|
66 |
64 |
$0.00 |
| G0398 |
Home sleep test/type 2 porta |
144 |
135 |
$0.00 |
| 59400 |
|
153 |
112 |
$0.00 |
| 90688 |
|
125 |
118 |
$0.00 |
| 90381 |
|
149 |
93 |
$0.00 |
| 99402 |
|
16 |
16 |
$0.00 |
| G0399 |
Home sleep test/type 3 porta |
59 |
58 |
$0.00 |
| 72170 |
|
17 |
14 |
$0.00 |
| 99153 |
Mod sedat endo service >5yrs |
16 |
16 |
$0.00 |
| 90689 |
|
17 |
15 |
$0.00 |
| 11200 |
|
13 |
12 |
$0.00 |
| 99451 |
|
12 |
12 |
$0.00 |
| 1159F |
|
1,774 |
1,489 |
$0.00 |
| 90648 |
|
2,629 |
1,860 |
$0.00 |
| 1160F |
|
1,740 |
1,461 |
$0.00 |
| 82947 |
|
135 |
120 |
$0.00 |
| 90700 |
|
337 |
239 |
$0.00 |
| J2930 |
Methylprednisolone injection |
14 |
14 |
$0.00 |
| 58563 |
|
90 |
87 |
$0.00 |
| 69209 |
|
18 |
12 |
$0.00 |
| 90750 |
|
32 |
29 |
$0.00 |
| G0500 |
Mod sedat endo service >5yrs |
254 |
237 |
$0.00 |
| 99051 |
|
112 |
109 |
$0.00 |
| G0179 |
Md recertification hha pt |
463 |
410 |
$0.00 |
| 90653 |
|
133 |
125 |
$0.00 |
| 99218 |
|
56 |
53 |
$0.00 |
| 76937 |
|
18 |
13 |
$0.00 |
| 90685 |
|
71 |
40 |
$0.00 |
| 93312 |
|
99 |
86 |
$0.00 |
| 90746 |
|
44 |
39 |
$0.00 |
| 00851 |
|
14 |
13 |
$0.00 |
| 31624 |
|
20 |
18 |
$0.00 |
| 58558 |
|
43 |
41 |
$0.00 |
| 76642 |
|
23 |
16 |
$0.00 |
| 01968 |
|
14 |
14 |
$0.00 |
| J2550 |
Promethazine hcl injection |
14 |
12 |
$0.00 |