| Code | Description | Total Paid |
|---|---|---|
| 97803 | $4K | |
| 99199 | Unlisted special service, procedure or report | $640.00 |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | $504.30 |
| 99307 | $155.80 |
| # | Provider | Location | Claims | Total Paid |
|---|---|---|---|---|
| 1 | YOUNG, SUSAN | DES PLAINES, IL | 48 | $4K |
| 2 | HUEMANKIND LLC | CHARLOTTE, NC | 248 | $640.00 |
| 3 | FLOWERS, FALLON | CHICAGO, IL | 12 | $504.30 |
| 4 | KRULY, SOPHIA | BUFFALO, NY | 16 | $155.80 |