Non Covered Codes Policy - uhccommunityplan-stage.uhc…€¦ · (as defined by UHC coverage...

REIMBURSEMENT POLICY

CMS-1500

Proprietary information of UnitedHealthcare Community Plan. Copyright 2015 United HealthCare Services, Inc. 2015R7102V

Non Covered Codes Policy

Policy Number

2015R7102V Annual Approval Date

7/08/2015 Approved By

Payment Policy Oversight Committee

IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY

You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement policies uses Current Procedural Terminology (CPT

*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines.

References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plans reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Community Plan enrollees. Other factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include, but are not limited to: federal &/or state regulatory requirements,

the physician or other provider contracts, the enrollees benefit coverage documents, and/or other reimbursement, medical or drug policies. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations. UnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication. UnitedHealthcare Community Plan uses a customized version of the Optum Claims Editing System known as iCES Clearinghouse to process claims in accordance with UnitedHealthcare Community Plan reimbursement policies.

*CPT is a registered trademark of the American Medical Association

Proprietary information of UnitedHealthcare Community and State

Copyright 2015 United HealthCare Services, Inc.

Application

This reimbursement policy applies to UnitedHealthcare Community Plan Medicaid products. This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals.

Payment Policies for Medicare & Retirement and Employer & Individual please use this link. Medicare & Retirement Policies are listed under Medicare Advantage Reimbursement Policies. Employer & Individual are listed under Reimbursement Policies-Commercial.

https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=ca174ccb4726b010VgnVCM100000c520720a____


CMS-1500


Policy

Overview

UnitedHealthcare Community Plan considers any CPT and HCPCS codes that are not on a state Medicaid fee schedule as not covered for that states Medicaid market unless there are benefit &/or contractual agreement with negotiated rates.

Reimbursement Guidelines

Not Covered

Any CPT and HCPCS codes that are not on the CMS NPFS but are on the state fee schedule will be covered for that states Medicaid market. All covered services are subject to all UnitedHealthcare Community Plan Reimbursement Policies and, although they will not deny as not covered services, may deny based on another policy. Any CPT and HCPCS codes that are not on the CMS NPFS, nor the state fee schedule, will deny as not covered. Any CPT and/or HCPCS code not on an individual state fee schedule will deny as not covered in that particular state unless there are benefit &/or contractual agreement with negotiated rates. Any code that is not covered in any UnitedHealthcare Community Plan market will be on the UnitedHealth Care Community Plan Non Covered Codes List. Some Medicaid Markets have a listing of covered codes, rather than non-covered codes. For these States, there will be a covered code list and any code not on the list will deny as not covered.

Medical Policy

CPT and HCPCS codes that are determined by UnitedHealthcare Community Plan Medical Policy to be unproven or experimental will not be reimbursed.

Category II Codes

Category II codes are used primarily for performance measurements and, per CMS, are not payable by Medicare. Upon review of the Medicaid fee schedules, UnitedHealthcare Community Plan has determined that the Category II codes are not payable in their Medicaid markets. Thus, Category II codes will not be payable in any UnitedHealthcare Community Plan markets.

Electronic Medical Records and E-prescribing Reporting Codes

These codes (G8443-G8449) are to be used for reporting the use of an e-prescribing or EMR system. Upon review of the Medicaid fee schedules, UnitedHealthcare Community Plan has determined that these codes are not payable in their Medicaid markets. Thus, G8443-G8449 will not be payable in any UnitedHealthcare Community Plan markets.

Benefit Considerations

The service requested must be reviewed against the language in the enrollee's benefit document. When the definitions of Experimental/Investigational Services and Unproven Services in the benefit document differ from the UnitedHealthcare Community Plan definition, it is the definition in the enrollee's benefit document that prevails.

State Exceptions

Arizona Arizona utilizes a Covered Code list.


CMS-1500


Delaware Delawares LTC product (Product ID DELTC) has a separate Non-Covered Code List. Per contract, code H0038 is covered for Tax ID 711018775.

Florida Floridas Medicaid covered codes can be found in their fee schedule at this link: http://portal.flmmis.com/FLPublic/Provider_ProviderSupport/Provider_ProviderSupport_FeeSchedules/tabId/44/Default.aspx

Hawaii Hawaiis Non-Covered Codes are not administered by this policy

Massachusetts Massachusetts Non-Covered Codes are not administered by this policy

Michigan Code 99420 is covered for the MIPHCP Plan ID only (dates of service prior to 1/1/14). This policy no longer applies to Michigan for claims with dates of service as of 1/1/14.

Mississippi Mississippis CHIP product (Plan ID MSCHIP) has a separate Non-Covered Code List

Nebraska Nebraskas Non-Covered Codes are not administered by this policy

New Jersey Code S5151 is covered for New Jersey Medicaid Family Care (Plan ID NJFAMCAR) only. Category II code 3008F (Body Mass Index, documented) is payable once per member, per year, per provider when all the following criteria are met:

Member age 3 years through 17 years

Category II code 3008F (Body Mass Index Documented) submitted with an E/M Service: 99201 Office/Op Visit, 99202 Office/Op Visit, 99203 Office/Op Visit, 99204 Office/Op Visit, 99205 Office/Op Visit, 99211 Office/Op Visit, 99212 Office/Op Visit, 99213 Office/Op Visit, 99214 Office/Op Visit, 99215 Office/Op Visit,

Submitted with one of the following diagnosis codes (the dx code should be appended to code 3008F): V85.5 Body Mass Index, pediatric [V85.5] V85.51 BMI,pediatric


CMS-1500


Texas Texas utilizes a Covered Code list.

Texas Star Plus (Plan ID TXSTPL) has a separate Covered Code List.

Per TMHP, effective for dates of service on or after January 1, 2015, certain procedure codes will no longer be reimbursed to free-standing and hospital-based ambulatory surgical centers

CPT codes 44381, 44403-44408, 45349, 45350, 45390-45393, 45398, 77385-77387, A4602, C9025, C9026, C9136, C9442, C9446, D0351, D6549, and D9987 are covered for MMP, Star, Star Plus, and CHIP only (excludes Perinate).

Washington Washingtons Non-Covered Codes are not administered by this policy

Wisconsin Category II code 3008F (Body Mass Index, documented) is payable once per member, per year, per provider when all the following criteria are met:

Member age 2 years through 18 years

Submitted with an E&M service

Submitted with one of the following diagnosis codes:

V85.51: Body Mass Index, pediatric, less than 5th percentile for age

V85.52: Body Mass Index, pediatric, 5th percentile to less than 85

th

percentile for age

V85.53: Body Mass Index, pediatric, 85th percentile to less than 95

th

percentile for age

V85.54: Body Mass Index, pediatric, greater than or equal to 95th

percentile for age

CPT code 99050 is not covered except for IPN providers who are allowed to bill due to contract requirements.

Definitions

Line of Business Identification number for various products within each market.

Experimental or Investigational Services

Medical, surgical, diagnostic, psychiatric, substance abuse or other health care services, technologies, supplies, treatments, procedures, drug therapies, medications or devices that, at the time we make a determination regarding coverage in a particular case, are determined to be any of the following:

Not approved by the U.S. Food and Drug Administration (FDA) to be lawfully marketed for the proposed use and not identified in the American Hospital Formulary Service or the United States Pharmacopoeia Dispensing Information as appropriate for the proposed use.

Subject to review and approval by any institutional review board for the proposed use. (Devices which are FDA approved under the Humanitarian Use Device exemption are not considered to be Experimental or Investigational.)

Unproven Services (as defined by UHC coverage determination guidelines)

Services, including medications, that are determined not to be effective for treatment of the medical condition and/or not to have a beneficial effect on health outcomes due to insufficient and inadequate clinical evidence from well-conducted randomized controlled trials or cohort studies in the prevailing published peer-reviewed medical literature.

Well-conducted randomized controlled trials. (Two or more treatments


CMS-1500


are compared to each other, and the patient is not allowed to choose which treatment is received.)

Well-conducted cohort studies. (Patients who receive study treatment are compared to a group of patients who receive standard therapy. The comparison group must be nearly identical to the study treatment group.)

Category II codes CPT Category II Procedure Codes are identified by the procedure code ending with "F", xxxxF, (example 1038F).

Questions and Answers

1

Q: What codes are considered non covered codes? A: Non covered codes are codes for services that are either considered non reimbursable per state guidelines, CMS or are reimbursable by a payer other than UnitedHealthcare Community Plan.

2

Q: How does UnitedHealthcare Community Plan determine which codes are not covered? A: UnitedHealthcare Community Plan follows state guidelines as outlined in the individual state provider manual, state website or other regulatory materials.

3 Q: Is the policy administered based on Date of Service or Date of Process? A: The policy is administered based on Date of Service.

Attachments: Please right-click on the icon to open the file.

2015A UnitedHealthcare Community Plan Codes Not Covered per Medical Policy

List of codes that are not covered based on UHG Medical Policies

2015A UnitedHealthcare Community Plan National Not Covered codes

List of codes not covered in any UnitedHealthcare Community Plan market.

State Specific Lists

States With Lists of Non-Covered Codes

2015B UnitedHealthcare Community Plan Delaware Medicaid Non-Covered Codes

List of CPT/HCPCS codes that are not covered for Delaware Medicaid

2015B UnitedHealthcare Community Plan Delaware LTC Non-Covered Codes

List of CPT/HCPCS codes that are not covered for Delaware LTC

2015C UnitedHealthcare Community Plan Iowa Medicaid Non-Covered Codes

List of CPT/HCPCS codes that are not covered for Iowa Medicaid

2015A UnitedHealthcare Community Plan Codes Not Covered Per Medical Policy

Code

0174T

0175T

0181T

0195T

0196T

0200T

0205T

0206T

0207T

0213T

0214T

0215T

0216T

0217T

0218T

0219T

0220T

0221T

0222T

0223T

0224T

0225T

0230T

0231T

0232T

0233T

G9147

S2348

S3890

kschal1File Attachment2015A UnitedHealthcare Community Plan Codes Not Covered Per Medical Policy.pdf

2015A UnitedHealthcare Community Plan Non Covered Codes

Code

P2031

kschal1File Attachment2015A UnitedHealthcare Community Plan Non Covered Codes.pdf

2015B UnitedHealthcare Community Plan DELAWARE MEDICAID Non Covered Codes

01990 0053T 4266F C1064 D6058 G8400 G9223 J8540 Q0081 S3630

15824 0054T 4267F C1065 D6059 G8401 G9224 J8560 Q0082 S3645

15877 0055T 4268F C1066 D6060 G8404 G9225 J8565 Q0083 S3650

15878 0058T 4269F C1087 D6061 G8405 G9226 J8597 Q0084 S3652

15879 0059T 4270F C1088 D6062 G8406 G9227 J8600 Q0085 S3655

17380 0071T 4271F C1094 D6063 G8410 G9228 J8610 Q0114 S3708

19300 0072T 4274F C1096 D6064 G8415 G9229 J8650 Q0117 S3800

22841 0075T 4276F C1097 D6065 G8416 G9230 J8700 Q0118 S3833

30220 0076T 4279F C1098 D6066 G8417 G9231 J8705 Q0119 S3834

30435 0078T 4280F C1099 D6067 G8418 G9232 J8999 Q0120 S3840

31513 0079T 4290F C1188 D6068 G8419 G9233 K0110 Q0121 S3841

31527 0080T 4293F C1202 D6069 G8420 G9234 K0111 Q0122 S3842

31529 0081T 4300F C1300 D6070 G8421 G9235 K0119 Q0123 S3844

31577 0085T 4301F C1348 D6071 G8422 G9236 K0120 Q0132 S3845

31590 0092T 4305F C1713 D6072 G8427 G9237 K0121 Q0144 S3846

31595 0095T 4306F C1714 D6073 G8428 G9238 K0122 Q0156 S3849

31614 0098T 4320F C1715 D6074 G8430 G9239 K0123 Q0162 S3850

32850 0099T 4322F C1716 D6075 G8431 G9240 K0124 Q0174 S3852

32855 0100T 4324F C1717 D6076 G8432 G9241 K0125 Q0181 S3853

32856 0101T 4325F C1719 D6077 G8433 G9242 K0126 Q0184 S3855

33930 0102T 4326F C1721 D6078 G8442 G9243 K0127 Q0488 S3861

33933 0103T 4328F C1722 D6079 G8450 G9244 K0128 Q0510 S3865

33940 0106T 4330F C1724 D6080 G8451 G9245 K0129 Q0511 S3866

33944 0107T 4340F C1725 D6090 G8452 G9246 K0130 Q0512 S3870

35180 0108T 4350F C1726 D6091 G8458 G9247 K0137 Q0513 S3890

35182 0109T 4400F C1727 D6092 G8459 G9248 K0138 Q0514 S3900

36416 0110T 4450F C1728 D6093 G8460 G9249 K0139 Q1004 S3902

36469 0111T 4470F C1729 D6094 G8461 G9250 K0140 Q1005 S3904

38542 0123T 4480F C1730 D6095 G8462 G9251 K0141 Q2026 S4005

42280 0124T 4481F C1731 D6100 G8463 G9252 K0143 Q2028 S4011

44132 0126T 4500F C1732 D6190 G8464 G9253 K0144 Q3017 S4013

44500 0159T 4510F C1733 D6194 G8465 G9254 K0145 Q3031 S4014

44715 0163T 4525F C1750 D6199 G8473 G9255 K0146 Q4001 S4015

44720 0164T 4526F C1751 D6205 G8474 G9256 K0152 Q4002 S4016

44721 0165T 4540F C1752 D6210 G8475 G9257 K0154 Q4003 S4017

47133 0169T 4541F C1753 D6214 G8476 G9258 K0163 Q4004 S4018

47140 0171T 4550F C1754 D6240 G8477 G9259 K0168 Q4005 S4020

47141 0172T 4551F C1755 D6245 G8478 G9260 K0169 Q4006 S4021

47142 0174T 4552F C1756 D6250 G8482 G9261 K0170 Q4007 S4022

47143 0175T 4553F C1757 D6253 G8483 G9262 K0171 Q4008 S4023

47144 0178T 4554F C1758 D6548 G8484 G9263 K0172 Q4009 S4025

47145 0179T 4555F C1759 D6600 G8485 G9264 K0173 Q4010 S4026

47146 0180T 4556F C1760 D6601 G8486 G9265 K0174 Q4011 S4027

47147 0181T 4557F C1762 D6602 G8487 G9266 K0175 Q4012 S4028

48400 0182T 4558F C1763 D6603 G8489 G9267 K0176 Q4013 S4030

48550 0183T 4559F C1764 D6604 G8490 G9268 K0177 Q4014 S4031

48551 0184T 4560F C1765 D6605 G8491 G9269 K0178 Q4015 S4035

48552 0185T 4561F C1766 D6606 G8492 G9270 K0179 Q4016 S4037

50300 0186T 4562F C1767 D6607 G8493 G9271 K0180 Q4017 S4040

50323 0188T 4563F C1768 D6608 G8494 G9272 K0181 Q4018 S4042

50325 0189T 5060F C1769 D6609 G8495 G9273 K0182 Q4019 S4981

50327 0190T 5062F C1770 D6610 G8496 G9274 K0190 Q4020 S4989

50328 0191T 5100F C1771 D6611 G8497 G9275 K0191 Q4021 S4990

50329 0192T 5200F C1772 D6612 G8498 G9276 K0192 Q4022 S4991

54164 0195T 5250F C1773 D6613 G8499 G9277 K0193 Q4023 S4993

54406 0196T 6040F C1776 D6614 G8500 G9278 K0194 Q4024 S4995

54415 0198T 6045F C1777 D6615 G8501 G9279 K0196 Q4025 S5000

54416 0199T 6070F C1778 D6624 G8502 G9280 K0197 Q4026 S5001

54417 0200T 6080F C1779 D6634 G8506 G9281 K0198 Q4027 S5010

55200 0201T 6090F C1780 D6710 G8509 G9282 K0199 Q4028 S5011

55300 0202T 6100F C1781 D6720 G8510 G9283 K0203 Q4029 S5012

55970 0205T 6101F C1782 D6740 G8511 G9284 K0204 Q4030 S5013

55980 0206T 6102F C1783 D6750 G8530 G9285 K0205 Q4031 S5014

57126 0207T 6110F C1784 D6780 G8531 G9286 K0206 Q4032 S5035

58310 0208T 6150F C1785 D6781 G8532 G9287 K0207 Q4033 S5036

58311 0209T 7020F C1786 D6782 G8535 G9288 K0208 Q4034 S5100

58974 0210T 7025F C1787 D6783 G8536 G9289 K0209 Q4035 S5108

59412 0211T 9001F C1788 D6790 G8539 G9290 K0210 Q4036 S5109

64755 0212T 9002F C1789 D6793 G8540 G9291 K0211 Q4037 S5110

66682 0213T 9003F C1813 D6794 G8541 G9292 K0212 Q4038 S5111

69090 0214T 9004F C1814 D6920 G8542 G9293 K0213 Q4039 S5115

69450 0215T 9005F C1815 D6940 G8543 G9294 K0214 Q4040 S5116

69661 0216T 9006F C1816 D6950 G8544 G9295 K0215 Q4041 S5120

74300 0217T 9007F C1817 D6975 G8545 G9296 K0216 Q4042 S5121

74742 0218T A0010 C1818 D7285 G8547 G9297 K0217 Q4043 S5125

75571 0219T A0020 C1819 D7286 G8548 G9298 K0218 Q4044 S5126

75982 0220T A0021 C1820 D7287 G8549 G9299 K0219 Q4045 S5131

77600 0221T A0030 C1821 D7288 G8551 G9300 K0220 Q4046 S5135

77605 0222T A0060 C1841 D7292 G8552 G9301 K0221 Q4047 S5136

77610 0329T A0080 C1874 D7293 G8553 G9302 K0222 Q4048 S5141

77615 0330T A0160 C1875 D7293 G8556 G9303 K0223 Q4050 S5146

78122 0331T A0220 C1876 D7410 G8557 G9304 K0224 Q4051 S5150

80049 0332T A0221 C1877 D7411 G8558 G9305 K0228 Q4082 S5151

80052 0333T A0222 C1878 D7412 G8559 G9306 K0229 Q4100 S5175

80054 0335T A0223 C1880 D7413 G8560 G9307 K0230 Q4101 S5180

80056 0336T A0308 C1881 D7414 G8561 G9308 K0234 Q4102 S5181

80057 0337T A0310 C1882 D7415 G8562 G9309 K0235 Q4103 S5185

80104 0338T A0322 C1883 D7440 G8563 G9310 K0236 Q4104 S5199

81287 0339T A0324 C1884 D7441 G8564 G9311 K0237 Q4105 S5565

81507 0340T A0328 C1885 D7450 G8565 G9312 K0238 Q4106 S5566

84830 0341T A0330 C1887 D7451 G8566 G9313 K0239 Q4107 S5570

86078 0342T A0342 C1888 D7460 G8567 G9314 K0240 Q4108 S5571

86079 0343T A0348 C1891 D7461 G8568 G9315 K0241 Q4110 S8030

86422 0344T A0350 C1892 D7465 G8569 G9316 K0242 Q4111 S8035

86910 0345T A0362 C1893 D7471 G8570 G9317 K0243 Q4112 S8037

86911 0346T A0368 C1894 D7472 G8571 G9318 K0244 Q4113 S8040

87631 0525F A0382 C1895 D7473 G8572 G9319 K0245 Q4114 S8048

87632 0526F A0384 C1896 D7485 G8573 G9320 K0246 Q4115 S8055

87633 0528F A0392 C1897 D7490 G8574 G9321 K0247 Q4116 S8060

87910 0529F A0394 C1898 D7610 G8575 G9322 K0248 Q4117 S8080

87912 0535F A0396 C1899 D7620 G8576 G9323 K0249 Q4118 S8085

88000 0540F A0398 C1900 D7630 G8577 G9324 K0250 Q4119 S8092

88005 0545F A0420 C1925 D7640 G8578 G9325 K0251 Q4120 S8096

88007 0550F A0425 C2614 D7650 G8579 G9326 K0252 Q4121 S8097

88012 0551F A0430 C2615 D7660 G8580 G9327 K0253 Q4130 S8100

88014 0555F A0433 C2616 D7670 G8581 G9328 K0254 Q4137 S8101

88016 0556F A0434 C2617 D7671 G8582 G9329 K0255 Q4138 S8110

88020 0557F A0888 C2618 D7680 G8583 G9340 K0256 Q4139 S8120

88025 0575F A0998 C2619 D7710 G8584 G9341 K0257 Q4140 S8121

88027 0580F A4211 C2620 D7720 G8585 G9342 K0258 Q4141 S8185

88028 0581F A4220 C2621 D7730 G8586 G9343 K0259 Q4142 S8186

88029 0582F A4261 C2622 D7740 G8587 G9344 K0260 Q4143 S8189

88036 0583F A4262 C2625 D7750 G8588 G9345 K0261 Q4145 S8200

88037 0584F A4263 C2626 D7760 G8589 G9346 K0262 Q4146 S8205

88040 1010F A4264 C2627 D7770 G8590 G9347 K0263 Q4147 S8210

88045 1011F A4266 C2628 D7771 G8591 G9348 K0264 Q4148 S8270

88323 1012F A4267 C2629 D7780 G8592 G9349 K0265 Q4149 S8300

88375 1031F A4268 C2630 D7810 G8593 G9350 K0266 Q5001 S8301

89250 1032F A4269 C2631 D7820 G8594 G9351 K0269 Q5002 S8402

89251 1033F A4270 C2634 D7830 G8595 G9352 K0270 Q5003 S8404

89253 1052F A4300 C2635 D7840 G8596 G9353 K0271 Q5004 S8415

89254 1130F A4301 C2636 D7850 G8597 G9354 K0272 Q5005 S8420

89255 1134F A4321 C2637 D7852 G8598 G9355 K0273 Q5006 S8421

89257 1135F A4350 C2638 D7854 G8599 G9356 K0274 Q5007 S8422

89258 1136F A4465 C2639 D7856 G8600 G9357 K0275 Q5008 S8423

89259 1137F A4520 C2640 D7858 G8601 G9358 K0276 Q5009 S8424

89260 1150F A4534 C2641 D7860 G8602 G9359 K0277 Q5010 S8425

89261 1151F A4550 C2642 D7865 G8603 G9360 K0278 Q9951 S8426

89264 1152F A4575 C2643 D7870 G8604 H0003 K0279 Q9953 S8427

89268 1153F A4580 C2698 D7871 G8605 H0004 K0280 Q9954 S8428

89272 1157F A4581 C2699 D7872 G8606 H0006 K0281 Q9959 S8429

89280 1158F A4590 C5271 D7873 G8607 H0008 K0283 Q9965 S8430

89281 1159F A4627 C5272 D7874 G8608 H0009 K0284 Q9966 S8431

89290 1160F A4641 C5273 D7875 G8609 H0010 K0285 Q9967 S8450

89291 1170F A4642 C5274 D7876 G8610 H0011 K0400 Q9968 S8451

89300 1175F A4648 C5275 D7877 G8611 H0012 K0401 R0070 S8452

89335 1180F A4649 C5276 D7920 G8612 H0013 K0402 R0075 S8460

89342 1181F A4650 C5277 D7940 G8613 H0014 K0403 R0076 S8490

89343 1182F A4651 C5278 D7941 G8614 H0016 K0404 S0012 S8930

89344 1183F A4652 C8900 D7943 G8615 H0021 K0405 S0014 S8940

89346 1200F A4655 C8901 D7944 G8616 H0022 K0406 S0088 S8950

89352 1205F A4657 C8902 D7945 G8617 H0023 K0407 S0090 S8990

89353 1220F A4680 C8903 D7946 G8618 H0024 K0408 S0092 S8999

89354 1400F A4690 C8904 D7947 G8619 H0025 K0409 S0093 S9001

89356 1450F A4700 C8905 D7948 G8620 H0026 K0410 S0104 S9007

89398 1451F A4705 C8906 D7949 G8621 H0027 K0411 S0106 S9015

90644 1460F A4706 C8907 D7950 G8622 H0028 K0412 S0108 S9023

90666 1461F A4707 C8908 D7951 G8623 H0029 K0417 S0109 S9024

90667 1490F A4708 C8909 D7953 G8624 H0030 K0418 S0117 S9025

90668 1491F A4709 C8910 D7955 G8625 H0033 K0419 S0122 S9033

90669 1493F A4714 C8911 D7972 G8626 H0034 K0420 S0126 S9055

90717 1494F A4719 C8912 D7980 G8627 H0035 K0421 S0128 S9056

90735 1500F A4721 C8913 D7981 G8628 H0038 K0422 S0132 S9085

90841 1501F A4722 C8914 D7982 G9001 H0040 K0423 S0136 S9090

90882 1502F A4723 C8918 D7983 G9003 H0041 K0424 S0137 S9097

90889 1503F A4724 C8919 D7990 G9004 H0042 K0425 S0138 S9098

90989 1504F A4725 C8920 D7991 G9010 H0044 K0426 S0139 S9117

90993 1505F A4726 C8921 D7995 G9013 H0045 K0427 S0140 S9126

92071 2015F A4730 C8922 D7996 G9014 H0047 K0428 S0142 S9140

92072 2016F A4735 C8923 D7998 G9016 H0048 K0429 S0157 S9141

92310 2040F A4736 C8924 D8693 G9017 H0049 K0430 S0160 S9150

92326 2044F A4737 C8925 D9211 G9018 H0050 K0431 S0166 S9152

92559 2050F A4740 C8926 D9212 G9019 H1000 K0432 S0170 S9209

92590 2060F A4750 C8927 D9215 G9020 H1001 K0433 S0172 S9212

92591 3008F A4755 C8928 D9410 G9033 H1002 K0434 S0174 S9213

92592 3015F A4760 C8929 D9420 G9034 H1003 K0435 S0175 S9214

92593 3016F A4765 C8930 D9430 G9035 H1004 K0436 S0176 S9325

92594 3018F A4766 C8956 D9450 G9036 H1005 K0437 S0177 S9329

92595 3019F A4770 C8957 D9630 G9037 H1010 K0438 S0178 S9335

92620 3038F A4771 C9019 D9941 G9050 H1011 K0439 S0179 S9339

92621 3055F A4772 C9020 D9942 G9051 H2000 K0440 S0182 S9373

92625 3056F A4773 C9100 D9950 G9052 H2001 K0441 S0183 S9381

92626 3115F A4774 C9108 D9951 G9053 H2010 K0442 S0187 S9401

92627 3117F A4780 C9110 D9952 G9054 H2013 K0443 S0189 S9430

92630 3118F A4790 C9113 D9970 G9055 H2014 K0444 S0194 S9433

92633 3119F A4800 C9114 D9971 G9056 H2015 K0445 S0197 S9435

92953 3125F A4801 C9115 D9972 G9057 H2017 K0446 S0199 S9453

92961 3250F A4802 C9121 D9973 G9058 H2019 K0447 S0201 S9454

93016 3267F A4820 C9132 D9974 G9059 H2022 K0448 S0207 S9472

94002 3293F A4850 C9133 E0150 G9060 H2025 K0449 S0208 S9473

94003 3294F A4860 C9248 E0151 G9061 H2026 K0450 S0250 S9475

94660 3321F A4870 C9250 E0152 G9062 H2028 K0451 S0255 S9476

94662 3322F A4880 C9254 E0183 G9063 H2029 K0453 S0257 S9480

94667 3323F A4890 C9257 E0195 G9064 H2030 K0462 S0260 S9482

94669 3324F A4900 C9290 E0218 G9065 H2031 K0501 S0265 S9485

94774 3328F A4901 C9352 E0252 G9066 H2032 K0503 S0270 S9527

94775 3330F A4905 C9353 E0270 G9067 H2033 K0504 S0271 S9528

94776 3331F A4910 C9354 E0315 G9068 H2034 K0505 S0272 S9529

94777 3340F A4911 C9355 E0350 G9069 H2037 K0506 S0273 S9538

94780 3341F A4912 C9356 E0352 G9070 H5010 K0507 S0274 S9810

94781 3342F A4913 C9358 E0370 G9071 H5020 K0508 S0280 S9900

95120 3343F A4914 C9359 E0453 G9072 H5025 K0509 S0281 S9960

95125 3344F A4918 C9360 E0455 G9073 H5030 K0511 S0302 S9961

95130 3345F A4919 C9361 E0458 G9074 H5040 K0512 S0310 S9970

95131 3350F A4920 C9362 E0460 G9075 H5050 K0513 S0315 S9975

95132 3351F A4921 C9363 E0505 G9077 H5060 K0514 S0316 S9976

95133 3352F A4928 C9364 E0510 G9078 H5090 K0515 S0317 S9977

95134 3353F A4929 C9408 E0515 G9079 H5100 K0516 S0320 S9981

95830 3354F A4931 C9416 E0555 G9080 H5110 K0518 S0340 S9982

95851 3370F A4932 C9434 E0580 G9083 H5120 K0519 S0341 S9986

95872 3372F A6025 C9441 E0602 G9084 H5130 K0520 S0342 S9988

95954 3374F A6250 C9497 E0616 G9085 H5160 K0521 S0353 S9989

95955 3376F A6260 C9724 E0746 G9086 H5170 K0522 S0354 S9990

95958 3378F A6413 C9725 E0751 G9087 H5190 K0523 S0395 S9991

96000 3380F A9150 C9726 E1356 G9088 H5200 K0524 S0400 S9992

96001 3382F A9152 C9727 E1400 G9089 H5220 K0525 S0504 S9994

96002 3384F A9153 C9728 E1404 G9090 H5230 K0526 S0506 S9996

96003 3386F A9180 C9734 E1500 G9091 H5240 K0527 S0508 S9999

96004 3388F A9270 C9735 E1637 G9092 H5299 K0528 S0510 T1003

96105 3390F A9275 C9737 E1638 G9093 J0200 K0529 S0514 T1004

96116 3394F A9279 C9898 E1639 G9094 J1446 K0551 S0515 T1006

96372 3395F A9281 C9899 E4610 G9095 J1741 K0740 S0518 T1009

96373 3450F A9282 D0180 G0002 G9096 J1817 K0899 S0590 T1010

96374 3451F A9284 D0350 G0004 G9097 J2545 L8604 S0595 T1012

96375 3452F A9300 D0415 G0005 G9098 J3101 L8605 S0596 T1013

96379 3455F A9500 D0416 G0006 G9099 J3530 L8679 S0601 T1014

97005 3470F A9501 D0417 G0007 G9100 J3535 L8699 S0613 T1016

97006 3471F A9502 D0418 G0015 G9101 J3570 M0075 S0618 T1017

97545 3472F A9503 D0421 G0016 G9102 J7303 M0076 S0622 T1018

97546 3475F A9504 D0425 G0050 G9103 J7304 M0100 S0630 T1019

97602 3476F A9505 D0431 G0129 G9104 J7306 M0260 S0800 T1020

97610 3490F A9507 D0475 G0131 G9105 J7308 M0261 S0810 T1021

98940 3491F A9508 D0476 G0132 G9106 J7310 M0300 S0812 T1022

98941 3492F A9509 D0477 G0159 G9107 J7311 M0301 S1001 T1027

98942 3493F A9510 D0478 G0160 G9108 J7315 M0526 S1002 T1028

98969 3494F A9512 D0479 G0161 G9109 J7330 M0530 S1015 T1030

99000 3495F A9516 D0481 G0163 G9110 J7500 M0535 S1016 T1031

99002 3496F A9517 D0482 G0164 G9111 J7506 M0575 S1030 T1035

99024 3497F A9520 D0483 G0165 G9112 J7507 M0580 S1031 T1502

99026 3498F A9521 D0484 G0173 G9113 J7508 M0590 S2050 T1503

99027 3500F A9524 D0485 G0185 G9114 J7509 M0702 S2052 T1505

99051 3502F A9526 D0486 G0186 G9115 J7510 M0704 S2053 T2004

99053 3503F A9527 D1310 G0194 G9116 J7515 M0710 S2054 T2005

99056 3510F A9528 D1330 G0197 G9117 J7517 M0900 S2055 T2007

99058 3511F A9529 D2410 G0199 G9123 J7518 M0910 S2060 T2010

99060 3512F A9530 D2420 G0201 G9124 J7520 P2028 S2061 T2011

99070 3513F A9531 D2430 G0219 G9125 J7527 P2029 S2065 T2012

99071 3514F A9532 D2510 G0240 G9126 J7604 P2031 S2066 T2013

99075 3520F A9536 D2520 G0241 G9128 J7605 P2032 S2067 T2017

99078 3550F A9537 D2530 G0251 G9129 J7606 P2033 S2068 T2023

99080 3551F A9538 D2542 G0269 G9130 J7607 P7001 S2070 T2024

99082 3552F A9539 D2543 G0293 G9131 J7608 P7020 S2079 T2026

99090 3555F A9540 D2544 G0294 G9132 J7609 P9005 S2080 T2027

99100 3570F A9541 D2610 G0295 G9133 J7610 P9006 S2095 T2028

99135 3572F A9542 D2620 G0302 G9134 J7615 P9007 S2102 T2029

99140 3573F A9543 D2630 G0303 G9135 J7620 P9010 S2103 T2030

99143 3650F A9544 D2642 G0304 G9136 J7622 P9011 S2112 T2032

99144 3700F A9545 D2643 G0305 G9137 J7624 P9012 S2115 T2034

99145 3720F A9546 D2644 G0333 G9138 J7626 P9013 S2117 T2036

99172 3725F A9547 D2650 G0339 G9139 J7627 P9014 S2118 T2037

99190 3750F A9548 D2651 G0340 G9140 J7628 P9015 S2120 T2039

99191 3751F A9550 D2652 G0378 G9148 J7629 P9016 S2140 T2041

99192 3752F A9551 D2662 G0379 G9149 J7631 P9017 S2142 T2042

99288 3753F A9552 D2663 G0380 G9150 J7632 P9018 S2150 T2043

99324 3754F A9553 D2664 G0381 G9151 J7633 P9019 S2152 T2044

99325 3755F A9554 D2720 G0382 G9152 J7634 P9020 S2190 T2045

99326 3756F A9555 D2740 G0383 G9153 J7635 P9021 S2202 T2046

99327 3757F A9556 D2750 G0384 G9156 J7636 P9022 S2204 T2048

99328 3758F A9557 D2780 G0390 G9187 J7637 P9023 S2205 T2049

99334 3759F A9558 D2783 G0402 G9188 J7638 P9024 S2206 T2101

99335 3760F A9559 D2790 G0405 G9189 J7639 P9031 S2207 T4536

99336 3761F A9560 D2794 G0406 G9190 J7640 P9032 S2208 T4537

99337 3762F A9561 D2960 G0408 G9191 J7641 P9033 S2209 T4538

99376 3763F A9562 D2961 G0409 G9192 J7642 P9034 S2210 T4539

99444 4004F A9563 D2962 G0410 G9193 J7643 P9035 S2225 T4540

99450 4008F A9564 D2971 G0411 G9194 J7644 P9036 S2230 T5999

99455 4010F A9566 D2975 G0412 G9195 J7645 P9037 S2235 V2702

99456 4013F A9567 D3331 G0413 G9196 J7647 P9038 S2260 V2745

99500 4063F A9568 D3460 G0414 G9197 J7648 P9039 S2265 V2755

99501 4069F A9569 D3920 G0415 G9198 J7649 P9040 S2266 V2756

99502 4086F A9570 D3950 G0428 G9199 J7657 P9042 S2267 V2761

99503 4140F A9571 D5281 G0429 G9200 J7658 P9044 S2300 V2770

99504 4142F A9572 D5710 G0436 G9201 J7659 P9050 S2340 V2780

99505 4144F A9575 D5711 G0437 G9202 J7667 P9051 S2341 V2781

99506 4145F A9576 D5720 G0438 G9203 J7668 P9052 S2342 V2786

99507 4148F A9577 D5721 G0439 G9204 J7669 P9053 S2348 V2787

99509 4149F A9578 D5860 G0442 G9205 J7674 P9054 S2350 V2788

99511 4192F A9579 D5861 G0443 G9206 J7676 P9055 S2351 V2797

99512 4193F A9580 D5862 G0444 G9207 J7680 P9056 S2360 V5010

99600 4194F A9581 D5867 G0445 G9208 J7681 P9057 S2361 V5011

99605 4195F A9582 D5875 G0450 G9209 J7682 P9058 S2401 V5020

99606 4196F A9599 D5982 G0451 G9210 J7683 P9059 S2402 V5110

99607 4240F A9600 D5983 G0463 G9211 J7684 P9060 S2403 V5160

0001F 4242F A9604 D5984 G6017 G9212 J7685 P9610 S2404 V5200

0005F 4245F A9698 D5985 G8126 G9213 J7699 P9612 S2409 V5240

0019T 4248F A9699 D6010 G8127 G9214 J7799 P9615 S2411 V5241

0042T 4250F A9700 D6012 G8128 G9215 J8498 Q0033 S2900 V5264

0051T 4255F A9901 D6040 G8395 G9216 J8499 Q0034 S3000 V5265

0052T 4256F B5200 D6050 G8396 G9217 J8501 Q0039 S3005 V5268

4260F C1012 D6053 G8397 G9218 J8510 Q0045 S3600 V5269

4261F C1013 D6054 G8398 G9219 J8515 Q0046 S3601 V5270

4265F C1014 D6055 G8399 G9220 J8520 Q0047 S3620 V5271

C1058 D6056 G9221 J8521 Q0066 S3625 V5272

D6057 G9222 J8530 Q0068 S3626 V5273

V5274

V5275

V5299

kschal1File Attachment2015B UnitedHealthcare Community Plan DELAWARE MEDICAID Non Covered Codes.pdf

2015B UnitedHealthcare Community Plan DELAWARE LTC Non Covered Codes

00003 70016 86288 99539 4550F C1894 D6611 G8271 J2915 L8699

10000 70171 86289 99551 4551F C1895 D6612 G8272 J2970 L9999

10001 70333 86290 99552 4552F C1896 D6613 G8273 J2994 M0075

10002 70374 86291 99553 4553F C1897 D6614 G8274 J2996 M0076

10003 70391 86293 99554 4554F C1898 D6615 G8275 J3005 M0100

10020 70541 86295 99555 4555F C1899 D6624 G8276 J3050 M0260

10100 71036 86296 99556 4556F C1900 D6634 G8277 J3080 M0261

10101 71037 86298 99557 4557F C1925 D6710 G8278 J3100 M0300

10141 71038 86299 99558 4558F C1929 D6720 G8279 J3101 M0301

11050 71041 86302 99559 4559F C1930 D6740 G8280 J3180 M0526

11051 71061 86303 99560 4560F C1931 D6750 G8281 J3245 M0530

11052 72241 86306 99561 4561F C1932 D6780 G8282 J3270 M0535

11060 72256 86311 99562 4562F C1933 D6781 G8283 J3340 M0575

11061 72266 86312 99563 4563F C1934 D6782 G8284 J3380 M0580

11062 72271 86313 99564 5005F C1935 D6783 G8285 J3390 M0590

11700 72286 86314 99565 5010F C1936 D6790 G8286 J3395 M0702

11701 72296 86315 99566 5015F C1937 D6793 G8287 J3450 M0704

11710 73041 86319 99567 5020F C1938 D6794 G8288 J3500 M0710

11711 73086 86333 99568 5050F C1939 D6920 G8289 J3530 M0900

11731 73116 86338 99569 5060F C1940 D6940 G8290 J3535 M0910

13135 73526 86342 99600 5062F C1941 D6950 G8291 J3540 P2028

13300 73581 86349 99605 5100F C1942 D6970 G8292 J3550 P2029

14300 73616 86358 99606 5200F C1943 D6971 G8293 J3560 P2031

15000 74300 86377 99607 5250F C1944 D6973 G8294 J3570 P2032

15001 74321 86379 0001F 5498X C1945 D6975 G8295 J6015 P2033

15342 74350 86385 0001T 6005F C1946 D6976 G8296 J7010 P2038

15343 74351 86386 0002F 6010F C1947 D6977 G8297 J7020 P3000

15350 74356 86404 0002T 6015F C1948 D7110 G8298 J7051 P7001

15351 74361 86405 0003F 6020F C1949 D7120 G8299 J7080 P7020

15410 74405 86410 0003T 6030F C1979 D7130 G8300 J7090 P9005

15412 74426 86411 0004F 6040F C1980 D7271 G8301 J7130 P9006

15414 74431 86412 0005F 6045F C1981 D7281 G8302 J7140 P9007

15416 74441 86417 0005T 6070F C2000 D7285 G8303 J7150 P9010

15500 74446 86418 0006F 6080F C2001 D7286 G8304 J7188 P9011

15505 74451 86419 0006T 6090F C2002 D7287 G8305 J7300 P9012

15510 74456 86420 0007F 6100F C2003 D7288 G8306 J7303 P9013

15515 74471 86421 0007T 6101F C2004 D7292 G8307 J7304 P9014

15540 74476 86422 0008F 6102F C2005 D7293 G8308 J7306 P9015

15545 74481 86423 0008T 6110F C2006 D7294 G8309 J7308 P9016

15550 74486 86455 0009F 6150F C2007 D7410 G8310 J7310 P9017

15555 74741 86540 0009T 7010F C2008 D7411 G8311 J7311 P9018

15580 74742 86585 0010F 7020F C2009 D7412 G8312 J7315 P9019

15625 75120 86586 0010T 7025F C2010 D7413 G8313 J7316 P9020

15700 75223 86587 0011F 9001F C2011 D7414 G8314 J7317 P9021

15710 75500 86588 0012F 9002F C2012 D7415 G8315 J7319 P9022

15720 75501 86594 0012T 9003F C2013 D7420 G8316 J7320 P9023

15730 75505 86595 0013T 9004F C2014 D7430 G8317 J7322 P9024

15755 75506 86600 0014F 9005F C2015 D7431 G8318 J7330 P9031

15790 75507 86630 0014T 9006F C2016 D7440 G8319 J7340 P9032

15791 75509 86650 0015F 9007F C2017 D7441 G8320 J7341 P9033

15810 75519 86662 0016T A0010 C2018 D7450 G8321 J7342 P9034

15811 75520 86681 0017T A0020 C2019 D7451 G8322 J7343 P9035

15824 75523 86683 0018T A0021 C2020 D7460 G8323 J7344 P9036

15831 75524 86685 0019T A0030 C2021 D7461 G8324 J7345 P9037

15850 75527 86781 0020T A0040 C2022 D7465 G8325 J7346 P9038

15877 75528 86910 0023T A0050 C2023 D7470 G8326 J7347 P9039

15878 75552 86911 0024T A0060 C2100 D7471 G8327 J7348 P9040

15879 75553 86915 0025T A0070 C2101 D7472 G8328 J7349 P9042

15954 75554 87060 0026T A0080 C2102 D7473 G8329 J7350 P9044

15955 75555 87072 0027T A0150 C2103 D7480 G8330 J7500 P9050

15960 75556 87082 0028T A0160 C2104 D7485 G8331 J7503 P9051

15961 75558 87083 0029T A0215 C2151 D7490 G8332 J7506 P9052

15964 75560 87085 0030T A0220 C2152 D7610 G8333 J7507 P9053

15965 75562 87087 0031T A0221 C2153 D7620 G8334 J7508 P9054

15966 75564 87117 0032T A0222 C2200 D7630 G8335 J7509 P9055

15967 75571 87145 0033T A0223 C2300 D7640 G8336 J7510 P9056

15970 75601 87151 0034T A0300 C2597 D7650 G8337 J7515 P9057

15971 75606 87155 0035T A0302 C2598 D7660 G8338 J7517 P9058

15972 75626 87163 0036T A0304 C2599 D7670 G8339 J7518 P9059

15973 75627 87174 0037T A0306 C2600 D7671 G8340 J7520 P9060

15974 75628 87175 0038T A0308 C2601 D7680 G8341 J7527 P9603

15975 75631 87178 0039T A0310 C2602 D7710 G8342 J7602 P9604

15980 75651 87179 0040T A0320 C2603 D7720 G8343 J7603 P9605

15981 75652 87192 0041T A0322 C2604 D7730 G8344 J7604 P9610

15982 75653 87198 0042T A0324 C2605 D7740 G8345 J7605 P9612

15983 75654 87199 0043T A0326 C2606 D7750 G8346 J7606 P9615

16010 75655 87208 0044T A0328 C2607 D7760 G8347 J7607 Q0033

16015 75656 87211 0045T A0330 C2608 D7770 G8348 J7608 Q0034

16040 75657 87631 0046T A0340 C2609 D7771 G8349 J7609 Q0036

16041 75659 87632 0047T A0342 C2610 D7780 G8350 J7610 Q0037

16042 75661 87633 0048T A0344 C2611 D7810 G8351 J7615 Q0038

17001 75663 87910 0049T A0346 C2612 D7820 G8352 J7616 Q0039

17002 75667 87912 0050T A0348 C2614 D7830 G8353 J7617 Q0040

17010 75669 88000 0051T A0350 C2615 D7840 G8354 J7618 Q0041

17100 75672 88005 0052T A0360 C2616 D7850 G8355 J7619 Q0042

17101 75673 88007 0053T A0362 C2617 D7852 G8356 J7620 Q0043

17102 75677 88012 0054T A0364 C2618 D7854 G8357 J7621 Q0045

17104 75678 88014 0055T A0366 C2619 D7856 G8358 J7622 Q0046

17105 75681 88016 0056T A0368 C2620 D7858 G8359 J7624 Q0047

17200 75682 88020 0057T A0370 C2621 D7860 G8360 J7625 Q0066

17201 75686 88025 0058T A0382 C2622 D7865 G8361 J7626 Q0068

17303 75687 88027 0059T A0384 C2625 D7870 G8362 J7627 Q0081

17304 75690 88028 0060T A0392 C2626 D7871 G8363 J7628 Q0082

17305 75692 88029 0061T A0394 C2627 D7872 G8364 J7629 Q0083

17306 75695 88036 0062T A0396 C2628 D7873 G8365 J7630 Q0084

17307 75697 88037 0063T A0398 C2629 D7874 G8366 J7631 Q0085

17310 75706 88040 0064T A0420 C2630 D7875 G8367 J7632 Q0086

17380 75711 88045 0065T A0425 C2631 D7876 G8368 J7633 Q0093

19140 75712 88099 0066T A0430 C2632 D7877 G8370 J7634 Q0094

19160 75717 88144 0067T A0432 C2633 D7920 G8371 J7635 Q0095

19162 75718 88145 0068T A0433 C2634 D7940 G8372 J7636 Q0096

19180 75723 88151 0069T A0434 C2635 D7941 G8373 J7637 Q0097

19182 75725 88156 0070T A0435 C2636 D7942 G8374 J7638 Q0098

19200 75727 88157 0071T A0800 C2637 D7943 G8375 J7639 Q0100

19220 75728 88158 0072T A0888 C2638 D7944 G8376 J7640 Q0101

19240 75732 88170 0074T A0998 C2639 D7945 G8377 J7641 Q0102

19300 75734 88171 0075T A0999 C2640 D7946 G8378 J7642 Q0103

19360 75737 88180 0076T A2000 C2641 D7947 G8379 J7643 Q0104

19362 75738 88250 0077T A4026 C2642 D7948 G8380 J7644 Q0109

20801 75742 88260 0078T A4190 C2643 D7949 G8381 J7645 Q0110

20804 75744 88317 0079T A4200 C2676 D7950 G8382 J7647 Q0111

20806 75747 88323 0080T A4202 C2698 D7951 G8383 J7648 Q0112

20812 75748 88345 0081T A4203 C2699 D7953 G8384 J7649 Q0113

20820 75750 88375 0082T A4204 C2700 D7955 G8385 J7650 Q0114

20823 75751 88380 0083T A4205 C2701 D7972 G8386 J7651 Q0115

20826 75752 88381 0084T A4211 C2702 D7980 G8387 J7652 Q0116

20828 75753 88388 0085T A4214 C2703 D7981 G8388 J7653 Q0117

20832 75754 88400 0086T A4220 C2704 D7982 G8389 J7654 Q0118

20834 75755 89205 0087T A4253 C2801 D7983 G8390 J7655 Q0119

20840 75757 89250 0088T A4254 C2802 D7990 G8391 J7657 Q0120

20901 75762 89251 0089T A4260 C2803 D7991 G8395 J7658 Q0121

20960 75764 89252 0090T A4261 C2804 D7992 G8396 J7659 Q0122

20971 75766 89253 0091T A4262 C2805 D7993 G8397 J7660 Q0123

20976 75767 89254 0092T A4263 C2806 D7994 G8398 J7665 Q0132

20986 75775 89255 0093T A4264 C2807 D7995 G8399 J7667 Q0136

20987 75790 89256 0094T A4266 C2808 D7996 G8400 J7668 Q0137

21041 75802 89257 0095T A4267 C3001 D7998 G8401 J7669 Q0144

21144 75804 89258 0096T A4268 C3002 D8110 G8402 J7670 Q0156

21200 75806 89259 0097T A4269 C3003 D8120 G8403 J7672 Q0157

21202 75808 89260 0098T A4270 C3004 D8360 G8404 J7674 Q0160

21203 75811 89261 0099T A4300 C3400 D8370 G8405 J7675 Q0161

21204 75821 89264 0100T A4301 C3401 D8460 G8406 J7676 Q0162

21250 75823 89268 0101T A4319 C3500 D8470 G8407 J7680 Q0174

21254 75826 89272 0102T A4321 C3510 D8480 G8408 J7681 Q0181

21300 75828 89280 0103T A4323 C3551 D8560 G8409 J7682 Q0182

21455 75832 89281 0104T A4324 C3552 D8570 G8410 J7683 Q0183

21493 75834 89290 0105T A4325 C3553 D8580 G8415 J7684 Q0184

21494 75841 89291 0106T A4329 C3554 D8650 G8416 J7685 Q0185

21633 75843 89300 0107T A4336 C3555 D8693 G8417 J7699 Q0186

22105 75861 89329 0108T A4347 C3556 D8750 G8418 J7799 Q0187

22106 75871 89330 0109T A4348 C3557 D9211 G8419 J8498 Q0488

22107 75873 89335 0110T A4350 C3800 D9212 G8420 J8499 Q0505

22140 75881 89342 0111T A4359 C3801 D9215 G8421 J8501 Q0506

22141 75886 89343 0115T A4360 C3851 D9240 G8422 J8510 Q0510

22142 75888 89344 0116T A4370 C4000 D9410 G8423 J8515 Q0511

22145 75890 89346 0117T A4374 C4001 D9420 G8424 J8520 Q0512

22148 75892 89350 0120T A4386 C4002 D9430 G8425 J8521 Q0513

22150 75895 89352 0123T A4454 C4003 D9450 G8426 J8530 Q0514

22151 75897 89353 0124T A4460 C4004 D9630 G8427 J8540 Q1001

22152 75941 89354 0126T A4462 C4005 D9941 G8428 J8560 Q1002

22230 75950 89355 0130T A4464 C4006 D9942 G8429 J8565 Q1003

22526 75951 89356 0133T A4465 C4007 D9950 G8430 J8597 Q1004

22527 75955 89360 0135T A4520 C4008 D9951 G8431 J8600 Q1005

22625 75963 89365 0137T A4521 C4009 D9952 G8432 J8610 Q2001

22650 75965 89398 0140T A4522 C4300 D9960 G8433 J8650 Q2002

22820 75967 89399 0141T A4523 C4301 D9970 G8434 J8700 Q2003

22841 75969 90000 0142T A4524 C4302 D9971 G8435 J8705 Q2005

22899 75971 90010 0143T A4525 C4303 D9972 G8436 J8999 Q2006

23221 75979 90015 0144T A4526 C4304 D9973 G8437 J9170 Q2007

23222 75981 90017 0145T A4527 C4305 D9974 G8438 J9180 Q2008

23510 75982 90020 0146T A4528 C4306 E0142 G8439 J9182 Q2010

23580 75983 90030 0147T A4529 C4307 E0145 G8440 J9240 Q2011

23610 75985 90040 0148T A4530 C4308 E0146 G8441 J9295 Q2012

23658 75990 90050 0149T A4531 C4309 E0150 G8442 K0008 Q2013

24151 75998 90060 0150T A4532 C4310 E0151 G8443 K0013 Q2014

24153 76003 90070 0151T A4533 C4311 E0152 G8445 K0016 Q2015

24350 76005 90080 0152T A4534 C4312 E0159 G8446 K0021 Q2016

24351 76006 90100 0153T A4535 C4313 E0164 G8447 K0022 Q2018

24352 76012 90110 0154T A4536 C4314 E0166 G8448 K0023 Q2019

24354 76013 90115 0155T A4537 C4315 E0169 G8449 K0024 Q2020

24356 76020 90117 0156T A4538 C4316 E0176 G8450 K0025 Q2021

24506 76040 90130 0157T A4550 C4317 E0177 G8451 K0026 Q2022

24510 76061 90140 0158T A4555 C4600 E0178 G8452 K0027 Q2023

24531 76062 90150 0159T A4560 C4601 E0179 G8453 K0028 Q2024

24536 76065 90160 0160T A4572 C4602 E0180 G8454 K0029 Q2026

24540 76066 90170 0161T A4575 C4603 E0183 G8455 K0030 Q2028

24542 76070 90200 0162T A4580 C4604 E0192 G8456 K0031 Q3000

24570 76071 90215 0163T A4581 C4605 E0195 G8457 K0032 Q3002

24578 76075 90220 0164T A4590 C4606 E0218 G8458 K0033 Q3003

24580 76076 90225 0165T A4609 C4607 E0237 G8459 K0034 Q3004

24581 76077 90240 0166T A4610 C5000 E0252 G8460 K0035 Q3005

24583 76078 90250 0167T A4621 C5001 E0270 G8461 K0036 Q3006

24585 76081 90260 0168T A4622 C5002 E0298 G8462 K0048 Q3007

24588 76082 90270 0169T A4627 C5003 E0315 G8463 K0049 Q3008

24610 76083 90280 0170T A4631 C5004 E0350 G8464 K0054 Q3009

24625 76085 90282 0171T A4632 C5005 E0352 G8465 K0055 Q3010

24660 76086 90292 0172T A4641 C5006 E0370 G8466 K0057 Q3011

24680 76087 90300 0173T A4642 C5007 E0400 G8467 K0058 Q3012

25005 76088 90315 0174T A4643 C5008 E0405 G8468 K0059 Q3014

25317 76089 90320 0175T A4644 C5009 E0410 G8469 K0060 Q3017

25318 76090 90340 0176T A4645 C5010 E0415 G8470 K0061 Q3019

25330 76091 90350 0177T A4646 C5011 E0416 G8471 K0062 Q3020

25331 76092 90360 0178T A4647 C5012 E0433 G8472 K0063 Q3021

25510 76093 90370 0179T A4648 C5013 E0451 G8473 K0064 Q3022

25540 76094 90378 0180T A4649 C5014 E0452 G8474 K0066 Q3023

25570 76095 90379 0181T A4650 C5015 E0453 G8475 K0067 Q3031

25610 76096 90389 0182T A4651 C5016 E0454 G8476 K0068 Q4001

25611 76097 90400 0183T A4652 C5017 E0455 G8477 K0074 Q4002

25615 76355 90410 0184T A4655 C5018 E0458 G8478 K0075 Q4003

25620 76360 90415 0185T A4656 C5019 E0460 G8479 K0076 Q4004

25626 76361 90420 0186T A4657 C5020 E0505 G8480 K0078 Q4005

25640 76362 90421 0187T A4680 C5021 E0510 G8481 K0079 Q4006

25665 76365 90430 0188T A4690 C5022 E0515 G8482 K0080 Q4007

26255 76366 90440 0189T A4700 C5023 E0555 G8483 K0081 Q4008

26261 76370 90450 0190T A4705 C5024 E0580 G8484 K0082 Q4009

26504 76375 90500 0191T A4706 C5025 E0590 G8485 K0083 Q4010

26527 76393 90505 0192T A4707 C5026 E0602 G8486 K0084 Q4011

26552 76394 90510 0193T A4708 C5027 E0607 G8487 K0085 Q4012

26557 76400 90515 0194T A4709 C5028 E0608 G8488 K0086 Q4013

26558 76490 90517 0195T A4712 C5029 E0609 G8489 K0087 Q4014

26559 76778 90520 0196T A4714 C5030 E0616 G8490 K0088 Q4015

26585 76855 90530 0198T A4719 C5031 E0620 G8491 K0089 Q4016

26597 76925 90540 0199T A4720 C5032 E0631 G8492 K0090 Q4017

26610 76926 90550 0200T A4721 C5033 E0671 G8493 K0091 Q4018

26655 76931 90560 0201T A4722 C5034 E0672 G8494 K0092 Q4019

26660 76933 90570 0202T A4723 C5035 E0673 G8495 K0093 Q4020

26680 76934 90580 0203T A4724 C5036 E0690 G8496 K0094 Q4021

26710 76935 90581 0204T A4725 C5037 E0701 G8497 K0095 Q4022

26730 76938 90590 0205T A4726 C5038 E0740 G8498 K0096 Q4023

26744 76939 90592 0206T A4730 C5039 E0746 G8499 K0097 Q4024

26760 76943 90600 0207T A4735 C5040 E0749 G8500 K0099 Q4025

26780 76947 90605 0208T A4736 C5041 E0750 G8501 K0100 Q4026

27010 76949 90610 0209T A4737 C5042 E0751 G8502 K0101 Q4027

27015 76960 90620 0210T A4740 C5043 E0752 G8503 K0102 Q4028

27079 76986 90630 0211T A4750 C5044 E0753 G8504 K0103 Q4029

27126 77380 90633 0212T A4755 C5045 E0754 G8505 K0104 Q4030

27127 77381 90634 0213T A4760 C5046 E0756 G8506 K0106 Q4031

27157 77400 90636 0214T A4765 C5047 E0757 G8507 K0107 Q4032

27190 77405 90640 0215T A4766 C5048 E0758 G8508 K0109 Q4033

27192 77410 90641 0216T A4770 C5130 E0759 G8509 K0110 Q4034

27195 77415 90642 0217T A4771 C5131 E0760 G8510 K0111 Q4035

27196 77419 90643 0218T A4772 C5132 E0782 G8511 K0112 Q4036

27201 77420 90644 0219T A4773 C5133 E0783 G8512 K0113 Q4037

27210 77430 90645 0220T A4774 C5134 E0785 G8513 K0114 Q4038

27212 77465 90646 0221T A4780 C5271 E0786 G8514 K0115 Q4039

27214 77499 90647 0222T A4790 C5272 E0943 G8515 K0116 Q4040

27224 77600 90648 0329T A4800 C5273 E0953 G8516 K0117 Q4041

27225 77605 90650 0330T A4801 C5274 E0954 G8517 K0118 Q4042

27234 77610 90651 0331T A4802 C5275 E0962 G8518 K0119 Q4043

27242 77615 90652 0332T A4820 C5276 E0963 G8519 K0120 Q4044

27255 77781 90653 0333T A4850 C5277 E0964 G8520 K0121 Q4045

27299 77782 90654 0335T A4860 C5278 E0965 G8521 K0122 Q4046

27315 77783 90659 0336T A4870 C5279 E0972 G8522 K0123 Q4047

27320 77784 90661 0337T A4880 C5280 E0975 G8523 K0124 Q4048

27504 77799 90663 0338T A4890 C5281 E0976 G8524 K0125 Q4049

27512 78007 90666 0339T A4900 C5282 E0977 G8525 K0126 Q4050

27518 78017 90667 0340T A4901 C5283 E0979 G8526 K0127 Q4051

27522 78099 90668 0341T A4905 C5284 E0991 G8527 K0128 Q4054

27534 78122 90669 0342T A4910 C5600 E0993 G8528 K0129 Q4055

27537 78160 90676 0343T A4911 C5601 E0996 G8529 K0130 Q4075

27554 78162 90681 0344T A4912 C6001 E0997 G8530 K0131 Q4076

27564 78170 90682 0345T A4913 C6002 E0998 G8531 K0132 Q4077

27599 78172 90690 0346T A4914 C6003 E0999 G8532 K0133 Q4080

27754 78186 90692 0500F A4918 C6004 E1000 G8533 K0134 Q4082

27764 78192 90693 0501F A4919 C6005 E1001 G8534 K0135 Q4083

27782 78193 90696 0502F A4920 C6006 E1012 G8535 K0136 Q4084

27790 78199 90698 0503F A4921 C6012 E1013 G8536 K0137 Q4085

27800 78225 90699 0505F A4928 C6013 E1019 G8537 K0138 Q4086

27802 78267 90700 0507F A4929 C6014 E1021 G8538 K0139 Q4087

27804 78268 90701 0509F A4931 C6015 E1025 G8539 K0140 Q4088

27806 78276 90702 0513F A4932 C6016 E1026 G8540 K0141 Q4089

27812 78280 90704 0514F A5064 C6017 E1027 G8541 K0142 Q4090

27820 78299 90705 0516F A5065 C6018 E1036 G8542 K0143 Q4091

27844 78310 90706 0517F A5074 C6019 E1065 G8543 K0144 Q4092

28030 78350 90708 0518F A5075 C6020 E1066 G8544 K0145 Q4093

28236 78380 90709 0519F A5119 C6021 E1069 G8545 K0146 Q4094

28410 78381 90710 0520F A5123 C6022 E1091 G8546 K0147 Q4095

28440 78399 90711 0521F A5149 C6023 E1210 G8547 K0148 Q4096

28460 78415 90712 0525F A5502 C6024 E1211 G8548 K0149 Q4097

28480 78425 90713 0526F A5509 C6025 E1212 G8549 K0150 Q4098

28500 78435 90716 0528F A5511 C6026 E1213 G8550 K0151 Q4099

28520 78455 90717 0529F A6020 C6027 E1340 G8551 K0152 Q4100

28550 78460 90719 0535F A6025 C6028 E1350 G8552 K0153 Q4101

28580 78461 90720 0540F A6200 C6029 E1356 G8553 K0154 Q4102

28610 78464 90721 0545F A6201 C6030 E1375 G8556 K0162 Q4103

28640 78465 90723 0550F A6202 C6031 E1377 G8557 K0163 Q4104

28670 78467 90724 0551F A6250 C6032 E1378 G8558 K0164 Q4105

29220 78470 90725 0555F A6260 C6033 E1379 G8559 K0165 Q4106

29455 78471 90726 0556F A6263 C6034 E1380 G8560 K0166 Q4107

29815 78474 90727 0557F A6264 C6035 E1381 G8561 K0167 Q4108

29909 78475 90728 0575F A6265 C6036 E1382 G8562 K0168 Q4110

29999 78476 90730 0580F A6405 C6037 E1383 G8563 K0169 Q4111

30220 78477 90731 0581F A6406 C6038 E1384 G8564 K0170 Q4112

30435 78478 90735 0582F A6413 C6039 E1385 G8565 K0171 Q4113

30800 78479 90737 0583F A6421 C6040 E1388 G8566 K0172 Q4114

30805 78480 90738 0584F A6422 C6041 E1389 G8567 K0173 Q4115

30820 78484 90741 1000F A6424 C6050 E1393 G8568 K0174 Q4116

31041 78485 90742 1000H A6426 C6051 E1394 G8569 K0175 Q4117

31071 78486 90745 1001F A6428 C6052 E1395 G8570 K0176 Q4118

31245 78487 90748 1002F A6430 C6053 E1396 G8571 K0177 Q4119

31246 78489 90750 1003F A6432 C6054 E1400 G8572 K0178 Q4120

31247 78499 90751 1004F A6434 C6055 E1401 G8573 K0179 Q4121

31248 78581 90752 1005F A6436 C6056 E1402 G8574 K0180 Q4130

31249 78582 90753 1006F A6438 C6057 E1403 G8575 K0181 Q4137

31250 78599 90754 1007F A6440 C6058 E1404 G8576 K0182 Q4138

31251 78615 90755 1008F A6542 C6080 E1500 G8577 K0183 Q4139

31252 78652 90757 1010F A6543 C6200 E1637 G8578 K0184 Q4140

31258 78655 90760 1010H A6551 C6201 E1638 G8579 K0185 Q4141

31260 78699 90761 1011F A7019 C6202 E1639 G8580 K0186 Q4142

31261 78704 90762 1011H A9150 C6203 E1640 G8581 K0187 Q4143

31262 78715 90763 1012F A9152 C6204 E1700 G8582 K0188 Q4145

31263 78726 90764 1012H A9153 C6205 E1800 G8583 K0189 Q4146

31264 78727 90765 1013H A9160 C6206 E1801 G8584 K0190 Q4147

31265 78760 90766 1015F A9170 C6207 E1805 G8585 K0191 Q4148

31266 78799 90767 1015H A9180 C6208 E1806 G8586 K0192 Q4149

31268 78810 90768 1016H A9190 C6209 E1810 G8587 K0193 Q5001

31269 78890 90769 1018F A9250 C6210 E1811 G8588 K0194 Q5002

31270 78891 90770 1019F A9260 C6300 E1815 G8589 K0196 Q5003

31271 78990 90771 1020H A9270 C6500 E1816 G8590 K0197 Q5004

31275 78999 90772 1021H A9275 C6501 E1818 G8591 K0198 Q5005

31277 79000 90773 1022F A9276 C6525 E1820 G8592 K0199 Q5006

31280 79001 90774 1022H A9277 C6600 E1821 G8593 K0203 Q5007

31281 79020 90775 1023H A9278 C6650 E1825 G8594 K0204 Q5008

31282 79030 90776 1026F A9279 C6651 E1830 G8595 K0205 Q5009

31283 79035 90778 1030F A9281 C6652 E1840 G8596 K0206 Q5010

31284 79100 90779 1031F A9282 C6700 E1900 G8597 K0207 Q9920

31285 79400 90780 1032F A9284 C8099 E2223 G8598 K0208 Q9921

31286 79420 90781 1033F A9290 C8100 E2320 G8599 K0209 Q9922

31513 79900 90782 1034F A9300 C8102 E2393 G8600 K0210 Q9923

31527 79999 90783 1035F A9500 C8103 E2399 G8601 K0211 Q9924

31529 80002 90784 1036F A9501 C8500 E2618 G8602 K0212 Q9925

31577 80003 90788 1038F A9502 C8501 E4610 G8603 K0213 Q9926

31585 80004 90798 1039F A9503 C8502 G0001 G8604 K0214 Q9927

31586 80005 90799 1040F A9504 C8503 G0002 G8605 K0215 Q9928

31590 80006 90820 1050F A9505 C8504 G0004 G8606 K0216 Q9929

31595 80007 90825 1052F A9507 C8505 G0005 G8607 K0217 Q9930

31614 80008 90830 1055F A9508 C8506 G0006 G8608 K0218 Q9931

31659 80009 90835 1060F A9509 C8507 G0007 G8609 K0219 Q9932

31700 80010 90841 1061F A9510 C8508 G0008 G8610 K0220 Q9933

31708 80011 90842 1065F A9511 C8509 G0009 G8611 K0221 Q9934

31710 80012 90843 1066F A9512 C8510 G0010 G8612 K0222 Q9935

31719 80016 90844 1070F A9513 C8511 G0015 G8613 K0223 Q9936

32000 80018 90855 1071F A9514 C8512 G0016 G8614 K0224 Q9937

32001 80019 90871 1080F A9515 C8513 G0020 G8615 K0228 Q9938

32002 80031 90875 1090F A9516 C8514 G0021 G8616 K0229 Q9939

32005 80032 90876 1091F A9517 C8516 G0025 G8617 K0230 Q9940

32019 80033 90882 1100F A9518 C8518 G0026 G8618 K0234 Q9945

32020 80034 90887 1101F A9519 C8519 G0027 G8619 K0235 Q9946

32315 80040 90889 1110F A9520 C8520 G0030 G8620 K0236 Q9947

32390 80042 90900 1111F A9521 C8521 G0031 G8621 K0237 Q9948

32450 80049 90902 1116F A9522 C8522 G0032 G8622 K0238 Q9949

32485 80052 90904 1118F A9523 C8523 G0033 G8623 K0239 Q9950

32490 80054 90906 1119F A9524 C8524 G0034 G8624 K0240 Q9951

32520 80056 90908 1121F A9525 C8525 G0035 G8625 K0241 Q9952

32522 80057 90910 1123F A9526 C8526 G0036 G8626 K0242 Q9953

32525 80058 90915 1124F A9527 C8528 G0037 G8627 K0243 Q9954

32545 80059 90918 1125F A9528 C8529 G0038 G8628 K0244 Q9959

32700 80060 90919 1126F A9529 C8530 G0039 G9001 K0245 Q9965

32705 80062 90920 1127F A9530 C8531 G0040 G9003 K0246 Q9966

32850 80063 90921 1128F A9531 C8532 G0041 G9004 K0247 Q9967

32855 80064 90922 1130F A9532 C8533 G0042 G9010 K0248 Q9968

32856 80065 90923 1134F A9533 C8534 G0043 G9013 K0249 R0059

32999 80066 90924 1135F A9534 C8535 G0044 G9014 K0250 R0065

33100 80067 90925 1136F A9535 C8536 G0045 G9016 K0251 R0070

33200 80068 90939 1137F A9536 C8539 G0046 G9017 K0252 R0075

33201 80070 90940 1150F A9537 C8540 G0047 G9018 K0253 R0076

33219 80071 90988 1151F A9538 C8541 G0050 G9019 K0254 R0085

33232 80072 90989 1152F A9539 C8542 G0051 G9020 K0255 S0012

33242 80073 90990 1153F A9540 C8543 G0052 G9021 K0256 S0014

33245 80075 90991 1157F A9541 C8550 G0053 G9022 K0257 S0088

33246 80080 90992 1158F A9542 C8551 G0054 G9023 K0258 S0090

33247 80082 90993 1159F A9543 C8552 G0055 G9024 K0259 S0092

33248 80084 90994 1160F A9544 C8597 G0056 G9025 K0260 S0093

33253 80085 90995 1170F A9545 C8598 G0057 G9026 K0261 S0104

33260 80086 90998 1175F A9546 C8599 G0058 G9027 K0262 S0106

33350 80088 91032 1180F A9547 C8600 G0059 G9028 K0263 S0108

33407 80089 91033 1181F A9548 C8650 G0060 G9029 K0264 S0117

33408 80090 91060 1182F A9549 C8724 G0061 G9030 K0265 S0122

33452 80091 91100 1183F A9550 C8725 G0062 G9031 K0266 S0126

33480 80092 92071 1200F A9551 C8748 G0063 G9032 K0267 S0128

33481 80099 92072 1205F A9552 C8749 G0064 G9033 K0268 S0132

33482 80104 92280 1220F A9553 C8750 G0065 G9034 K0269 S0136

33483 81004 92310 1400F A9554 C8775 G0066 G9035 K0270 S0137

33485 81010 92314 1450F A9555 C8776 G0071 G9036 K0271 S0138

33490 81011 92326 1451F A9556 C8777 G0072 G9037 K0272 S0139

33492 81012 92330 1460F A9557 C8800 G0073 G9050 K0273 S0140

33520 81030 92335 1461F A9558 C8801 G0074 G9051 K0274 S0142

33525 81287 92340 1490F A9559 C8802 G0075 G9052 K0275 S0147

33528 81507 92341 1491F A9560 C8830 G0076 G9053 K0276 S0157

33570 82005 92342 1493F A9561 C8890 G0077 G9054 K0277 S0160

33575 82011 92352 1494F A9562 C8891 G0078 G9055 K0278 S0166

33649 82012 92353 1500F A9563 C8900 G0079 G9056 K0279 S0170

33696 82015 92354 1501F A9564 C8901 G0080 G9057 K0280 S0172

33698 82035 92355 1502F A9565 C8902 G0081 G9058 K0281 S0174

33738 82060 92358 1503F A9566 C8903 G0082 G9059 K0283 S0175

33739 82065 92370 1504F A9567 C8904 G0083 G9060 K0284 S0176

33830 82070 92371 1505F A9568 C8905 G0084 G9061 K0285 S0177

33855 82072 92390 2000F A9569 C8906 G0085 G9062 K0400 S0178

33865 82076 92391 2001F A9570 C8907 G0086 G9063 K0401 S0179

33918 82078 92392 2002F A9571 C8908 G0087 G9064 K0402 S0182

33919 82086 92393 2003F A9572 C8909 G0088 G9065 K0403 S0183

33930 82087 92395 2004F A9575 C8910 G0089 G9066 K0404 S0187

33933 82089 92396 2010F A9576 C8911 G0090 G9067 K0405 S0189

33940 82091 92499 2014F A9577 C8912 G0091 G9068 K0406 S0194

33944 82095 92510 2015F A9578 C8913 G0092 G9069 K0407 S0197

33972 82096 92525 2016F A9579 C8914 G0093 G9070 K0408 S0199

33981 82100 92559 2018F A9580 C8918 G0094 G9071 K0409 S0201

33982 82112 92566 2019F A9581 C8919 G0103 G9072 K0410 S0207

33983 82126 92569 2020F A9582 C8920 G0107 G9073 K0411 S0208

33999 82130 92573 2021F A9599 C8921 G0110 G9074 K0412 S0250

35161 82134 92574 2022F A9600 C8922 G0111 G9075 K0413 S0255

35162 82137 92578 2024F A9603 C8923 G0112 G9076 K0414 S0257

35180 82138 92580 2026F A9604 C8924 G0113 G9077 K0415 S0260

35182 82141 92581 2027F A9605 C8925 G0114 G9078 K0416 S0265

35381 82142 92589 2028F A9698 C8926 G0115 G9079 K0417 S0270

35507 82156 92590 2029F A9699 C8927 G0116 G9080 K0418 S0271

35541 82159 92591 2030F A9700 C8928 G0122 G9081 K0419 S0272

35546 82165 92592 2031F A9901 C8929 G0125 G9082 K0420 S0273

35582 82168 92593 2035F B4084 C8930 G0126 G9083 K0421 S0274

35641 82170 92594 2040F B4085 C8950 G0129 G9084 K0422 S0280

35900 82173 92595 2044F B4086 C8951 G0131 G9085 K0423 S0281

35910 82210 92598 2050F B4151 C8952 G0132 G9086 K0424 S0302

36145 82225 92599 2060F B4156 C8953 G0143 G9087 K0425 S0310

36230 82230 92620 3000F B4164 C8954 G0144 G9088 K0426 S0315

36416 82231 92621 3002F B4180 C8955 G0145 G9089 K0427 S0316

36469 82235 92625 3006F B4189 C8956 G0147 G9090 K0428 S0317

36488 82236 92626 3008F B4193 C8957 G0148 G9091 K0429 S0320

36489 82245 92627 3011F B4197 C9000 G0159 G9092 K0430 S0340

36490 82250 92630 3014F B4199 C9001 G0160 G9093 K0431 S0341

36491 82251 92633 3015F B5000 C9002 G0161 G9094 K0432 S0342

36493 82260 92953 3016F B5100 C9003 G0163 G9095 K0433 S0395

36495 82265 92961 3017F B5200 C9004 G0164 G9096 K0434 S0400

36496 82268 93016 3018F C1000 C9005 G0165 G9097 K0435 S0504

36497 82273 93201 3019F C1001 C9006 G0167 G9098 K0436 S0506

36520 82280 93202 3020F C1003 C9007 G0169 G9099 K0437 S0508

36521 82285 93204 3021F C1004 C9008 G0170 G9100 K0438 S0510

36530 82290 93205 3022F C1006 C9009 G0171 G9101 K0439 S0514

36531 82291 93208 3023F C1007 C9010 G0172 G9102 K0440 S0515

36532 82305 93209 3025F C1008 C9011 G0173 G9103 K0441 S0518

36533 82307 93210 3027F C1009 C9013 G0174 G9104 K0442 S0590

36534 82315 93220 3028F C1010 C9019 G0178 G9105 K0443 S0595

36535 82320 93221 3035F C1011 C9020 G0183 G9106 K0444 S0601

36536 82325 93222 3037F C1012 C9100 G0184 G9107 K0445 S0613

36537 82335 93255 3038F C1013 C9102 G0185 G9108 K0446 S0618

36540 82372 93536 3040F C1014 C9103 G0186 G9109 K0447 S0622

36550 82400 93546 3042F C1015 C9104 G0187 G9110 K0448 S0630

36834 82405 93547 3044F C1016 C9105 G0188 G9111 K0449 S0800

36840 82418 93548 3045F C1017 C9106 G0190 G9112 K0450 S0810

36845 82420 93549 3046F C1018 C9107 G0191 G9113 K0451 S0812

37190 82425 93550 3047F C1019 C9108 G0192 G9114 K0452 S1001

37720 82437 93551 3048F C1020 C9109 G0193 G9115 K0453 S1002

37730 82443 93552 3049F C1021 C9110 G0194 G9116 K0455 S1015

38204 82470 93553 3050F C1022 C9111 G0195 G9117 K0456 S1016

38207 82484 93607 3055F C1024 C9112 G0196 G9118 K0457 S1030

38208 82512 93651 3056F C1025 C9113 G0197 G9119 K0458 S1031

38209 82526 93668 3060F C1026 C9114 G0198 G9120 K0459 S2050

38210 82529 93727 3061F C1027 C9115 G0199 G9121 K0460 S2052

38211 82531 93731 3062F C1028 C9116 G0200 G9122 K0461 S2053

38212 82532 93732 3066F C1029 C9119 G0201 G9123 K0462 S2054

38213 82534 93733 3072F C1030 C9120 G0210 G9124 K0501 S2055

38214 82536 93734 3073F C1031 C9121 G0211 G9125 K0503 S2060

38215 82537 93735 3074F C1033 C9123 G0212 G9126 K0504 S2061

38231 82538 93736 3075F C1034 C9124 G0213 G9127 K0505 S2065

38542 82539 93737 3076F C1035 C9125 G0214 G9128 K0506 S2066

38999 82545 93738 3077F C1036 C9126 G0215 G9129 K0507 S2067

39020 82546 93740 3078F C1037 C9132 G0216 G9130 K0508 S2068

39499 82555 93741 3079F C1038 C9133 G0217 G9131 K0509 S2070

39547 82601 93742 3080F C1039 C9200 G0218 G9132 K0511 S2079

39599 82606 93743 3082F C1040 C9201 G0219 G9133 K0512 S2080

40799 82614 93744 3083F C1042 C9202 G0220 G9134 K0513 S2095

42280 82620 93760 3084F C1043 C9203 G0221 G9135 K0514 S2102

42299 82624 93762 3085F C1045 C9205 G0222 G9136 K0515 S2103

42325 82628 93850 3088F C1047 C9206 G0223 G9137 K0516 S2112

42326 82635 93860 3089F C1048 C9207 G0224 G9138 K0518 S2115

42699 82636 93870 3090F C1050 C9208 G0225 G9139 K0519 S2117

42880 82639 93910 3091F C1051 C9209 G0226 G9140 K0520 S2118

43000 82640 93920 3092F C1053 C9210 G0227 G9141 K0521 S2120

43040 82641 93921 3093F C1054 C9211 G0228 G9142 K0522 S2140

43105 82643 93950 3095F C1055 C9212 G0229 G9143 K0523 S2142

43106 82660 93960 3096F C1056 C9213 G0230 G9156 K0524 S2150

43110 82673 94002 3100F C1057 C9214 G0231 G9187 K0525 S2152

43111 82674 94003 3110F C1058 C9215 G0232 G9188 K0526 S2190

43115 82676 94005 3111F C1059 C9216 G0233 G9189 K0527 S2202

43119 82678 94160 3112F C1060 C9217 G0234 G9190 K0528 S2204

43120 82691 94470 3115F C1061 C9218 G0236 G9191 K0529 S2205

43136 82692 94650 3117F C1063 C9220 G0240 G9192 K0530 S2206

43289 82694 94651 3118F C1064 C9221 G0241 G9193 K0531 S2207

43321 82720 94652 3119F C1065 C9222 G0242 G9194 K0532 S2208

43451 82727 94656 3120F C1066 C9224 G0243 G9195 K0533 S2209

43455 82730 94657 3125F C1067 C9225 G0244 G9196 K0534 S2210

43499 82740 94660 3130F C1068 C9227 G0251 G9197 K0538 S2225

43625 82741 94662 3132F C1069 C9228 G0253 G9198 K0539 S2230

43630 82745 94665 3140F C1071 C9229 G0254 G9199 K0540 S2235

43638 82750 94667 3141F C1072 C9230 G0256 G9200 K0541 S2260

43639 82755 94669 3142F C1073 C9231 G0258 G9201 K0542 S2265

43659 82756 94700 3150F C1074 C9232 G0259 G9202 K0543 S2266

43750 82763 94705 3155F C1075 C9233 G0261 G9203 K0544 S2267

43844 82765 94710 3160F C1076 C9234 G0262 G9204 K0545 S2300

43885 82780 94715 3170F C1077 C9235 G0263 G9205 K0546 S2340

43999 82786 94774 3200F C1078 C9236 G0264 G9206 K0547 S2341

44040 82790 94775 3210F C1079 C9237 G0265 G9207 K0549 S2342

44131 82791 94776 3215F C1080 C9238 G0266 G9208 K0550 S2348

44132 82792 94777 3216F C1081 C9239 G0267 G9209 K0551 S2350

44152 82793 94780 3218F C1082 C9240 G0269 G9210 K0553 S2351

44153 82795 94781 3220F C1083 C9241 G0270 G9211 K0554 S2360

44200 82801 94799 3230F C1084 C9242 G0271 G9212 K0555 S2361

44201 82802 95000 3250F C1086 C9243 G0272 G9213 K0556 S2401

44209 82804 95001 3260F C1087 C9244 G0273 G9214 K0557 S2402

44239 82812 95002 3265F C1088 C9245 G0274 G9215 K0558 S2403

44305 82817 95003 3266F C1089 C9246 G0279 G9216 K0559 S2404

44500 82927 95005 3267F C1090 C9247 G0280 G9217 K0561 S2409

44600 82929 95006 3268F C1091 C9248 G0281 G9218 K0562 S2411

44610 82931 95007 3269F C1092 C9249 G0290 G9219 K0563 S2900

44715 82932 95011 3270F C1093 C9250 G0291 G9220 K0565 S3000

44720 82942 95014 3271F C1094 C9251 G0292 G9221 K0570 S3005

44721 82944 95016 3272F C1095 C9252 G0293 G9222 K0572 S3600

44799 82949 95020 3273F C1096 C9253 G0294 G9223 K0573 S3601

44899 82954 95021 3274F C1097 C9254 G0295 G9224 K0581 S3620

44979 82961 95022 3278F C1098 C9255 G0296 G9225 K0582 S3625

45170 82995 95023 3279F C1099 C9256 G0297 G9226 K0583 S3626

45180 83000 95030 3280F C1100 C9257 G0298 G9227 K0584 S3630

45302 83004 95031 3281F C1101 C9258 G0299 G9228 K0585 S3645

45310 83005 95032 3284F C1102 C9259 G0300 G9229 K0586 S3650

45336 83011 95033 3285F C1103 C9260 G0302 G9230 K0587 S3652

45499 83019 95034 3288F C1104 C9261 G0303 G9231 K0588 S3655

45999 83040 95040 3290F C1105 C9262 G0304 G9232 K0589 S3701

46000 83052 95041 3291F C1106 C9263 G0305 G9233 K0590 S3708

46210 83053 95042 3292F C1107 C9350 G0306 G9234 K0591 S3800

46211 83086 95043 3293F C1109 C9351 G0307 G9235 K0592 S3833

46281 83087 95050 3294F C1110 C9352 G0308 G9236 K0593 S3834

46602 83093 95051 3300F C1111 C9353 G0309 G9237 K0594 S3840

46934 83094 95078 3301F C1112 C9354 G0310 G9238 K0595 S3841

46935 83095 95080 3302F C1113 C9355 G0311 G9239 K0596 S3842

46936 83485 95081 3303F C1114 C9356 G0312 G9240 K0597 S3843

46937 83486 95082 3304F C1115 C9357 G0313 G9241 K0600 S3844

46938 83492 95105 3305F C1116 C9358 G0314 G9242 K0618 S3845

46999 83493 95120 3306F C1117 C9359 G0315 G9243 K0619 S3846

47133 83494 95125 3307F C1118 C9360 G0316 G9244 K0620 S3849

47134 83495 95130 3308F C1119 C9361 G0317 G9245 K0627 S3850

47140 83496 95131 3309F C1120 C9362 G0318 G9246 K0628 S3852

47141 83510 95132 3310F C1121 C9363 G0319 G9247 K0629 S3853

47142 83523 95133 3311F C1122 C9364 G0320 G9248 K0630 S3855

47143 83524 95134 3312F C1123 C9399 G0321 G9249 K0631 S3861

47144 83526 95135 3313F C1124 C9400 G0322 G9250 K0632 S3865

47145 83530 95140 3314F C1125 C9401 G0323 G9251 K0633 S3866

47146 83545 95150 3315F C1126 C9402 G0324 G9252 K0634 S3870

47147 83546 95155 3316F C1127 C9403 G0325 G9253 K0635 S3890

47355 83555 95817 3317F C1128 C9404 G0326 G9254 K0636 S3900

47379 83565 95821 3318F C1129 C9405 G0327 G9255 K0637 S3902

47399 83571 95823 3319F C1130 C9408 G0328 G9256 K0638 S3904

47440 83576 95826 3320F C1131 C9410 G0332 G9257 K0639 S4005

47579 83578 95828 3321F C1132 C9411 G0333 G9258 K0640 S4011

47710 83583 95830 3322F C1133 C9412 G0336 G9259 K0641 S4013

47716 83584 95842 3323F C1134 C9413 G0337 G9260 K0642 S4014

47719 83587 95851 3324F C1135 C9414 G0338 G9261 K0643 S4015

47999 83588 95858 3325F C1136 C9415 G0339 G9262 K0644 S4016

48005 83589 95872 3328F C1137 C9416 G0340 G9263 K0645 S4017

48151 83590 95880 3330F C1143 C9417 G0344 G9264 K0646 S4018

48180 83597 95881 3331F C1144 C9418 G0345 G9265 K0647 S4020

48400 83599 95882 3340F C1145 C9419 G0346 G9266 K0648 S4021

48550 83600 95883 3341F C1146 C9420 G0347 G9267 K0649 S4022

48551 83610 95935 3342F C1147 C9421 G0348 G9268 K0650 S4023

48552 83620 95952 3343F C1148 C9422 G0349 G9269 K0651 S4025

48999 83624 95954 3344F C1149 C9423 G0350 G9270 K0652 S4026

49085 83626 95955 3345F C1151 C9424 G0351 G9271 K0653 S4027

49200 83628 95958 3350F C1152 C9425 G0353 G9272 K0654 S4028

49201 83629 96000 3351F C1153 C9426 G0354 G9273 K0655 S4030

49300 83645 96001 3352F C1154 C9427 G0355 G9274 K0656 S4031

49301 83650 96002 3353F C1155 C9428 G0356 G9275 K0657 S4035

49302 83660 96003 3354F C1156 C9429 G0357 G9276 K0658 S4036

49303 83675 96004 3370F C1157 C9430 G0358 G9277 K0659 S4037

49310 83680 96040 3372F C1158 C9431 G0359 G9278 K0660 S4040

49311 83681 96100 3374F C1159 C9432 G0360 G9279 K0661 S4042

49315 83685 96105 3376F C1160 C9433 G0361 G9280 K0662 S4981

49329 83705 96111 3378F C1161 C9434 G0362 G9281 K0663 S4989

49401 83715 96115 3380F C1162 C9435 G0363 G9282 K0664 S4990

49510 83716 96116 3382F C1163 C9436 G0366 G9283 K0665 S4991

49515 83717 96117 3384F C1164 C9437 G0367 G9284 K0666 S4993

49530 83720 96155 3386F C1166 C9438 G0368 G9285 K0667 S4995

49535 83725 96372 3388F C1167 C9439 G0369 G9286 K0668 S5000

49552 83728 96373 3390F C1170 C9441 G0370 G9287 K0670 S5001

49575 83730 96374 3394F C1171 C9497 G0371 G9288 K0740 S5010

49581 83740 96375 3395F C1172 C9500 G0374 G9289 K0899 S5011

49659 83750 96379 3450F C1173 C9501 G0375 G9290 L0100 S5012

50300 83755 96400 3451F C1174 C9502 G0376 G9291 L0101 S5013

50323 83760 96408 3452F C1175 C9503 G0377 G9292 L0110 S5014

50325 83765 96410 3455F C1176 C9504 G0378 G9293 L0210 S5035

50327 83790 96412 3470F C1177 C9505 G0379 G9294 L0300 S5036

50328 83795 96414 3471F C1178 C9700 G0380 G9295 L0310 S5100

50329 83799 96520 3472F C1179 C9701 G0381 G9296 L0315 S5108

50549 83830 96530 3475F C1180 C9702 G0382 G9297 L0317 S5110

50559 83842 96545 3476F C1181 C9703 G0383 G9298 L0320 S5111

50578 83845 96549 3490F C1182 C9704 G0384 G9299 L0321 S5115

50949 83859 97005 3491F C1183 C9708 G0389 G9300 L0330 S5116

50959 83860 97006 3492F C1184 C9711 G0390 G9301 L0331 S5120

50978 83861 97020 3493F C1188 C9712 G0392 G9302 L0340 S5121

51000 83862 97061 3494F C1200 C9713 G0393 G9303 L0350 S5135

51005 83865 97114 3495F C1201 C9714 G0394 G9304 L0360 S5136

51010 83875 97118 3496F C1202 C9715 G0402 G9305 L0370 S5141

51739 83895 97120 3497F C1203 C9716 G0405 G9306 L0380 S5146

51772 83910 97122 3498F C1205 C9718 G0406 G9307 L0390 S5150

51795 83917 97126 3500F C1207 C9719 G0408 G9308 L0391 S5151

52335 83920 97128 3502F C1300 C9720 G0409 G9309 L0400 S5175

52336 83938 97145 3503F C1302 C9721 G0410 G9310 L0410 S5180

52337 83946 97220 3510F C1303 C9722 G0411 G9311 L0420 S5181

52338 83947 97221 3511F C1304 C9723 G0412 G9312 L0440 S5185

52339 83948 97240 3512F C1305 C9724 G0413 G9313 L0474 S5199

52340 83949 97241 3513F C1306 C9725 G0414 G9314 L0476 S5565

52347 83965 97250 3514F C1311 C9726 G0415 G9315 L0478 S5566

52510 83971 97260 3515F C1312 C9727 G0428 G9316 L0500 S5570

52606 83972 97261 3520F C1313 C9728 G0429 G9317 L0510 S5571

52612 83973 97265 3550F C1314 C9734 G0430 G9318 L0515 S8030

52614 83975 97500 3551F C1315 C9735 G0431 G9319 L0520 S8035

52620 83985 97501 3552F C1316 C9737 G0436 G9320 L0530 S8037

52650 83995 97504 3555F C1317 C9898 G0437 G9321 L0540 S8040

53443 84005 97520 3570F C1318 C9899 G0438 G9322 L0550 S8048

53640 84021 97521 3572F C1319 D0110 G0439 G9323 L0560 S8055

53670 84031 97531 3573F C1320 D0130 G0442 G9324 L0561 S8060

53675 84033 97540 3650F C1321 D0180 G0443 G9325 L0565 S8080

53800 84037 97541 3700F C1322 D0275 G0444 G9326 L0600 S8085

53853 84038 97545 3720F C1323 D0350 G0445 G9327 L0610 S8092

54152 84039 97546 3725F C1324 D0410 G0450 G9328 L0620 S8093

54164 84040 97601 3750F C1325 D0415 G0451 G9329 L0860 S8095

54402 84045 97602 3751F C1326 D0416 G0463 G9340 L0900 S8096

54406 84065 97610 3752F C1328 D0417 G6017 G9341 L0910 S8097

54407 84082 97700 3753F C1329 D0418 G8006 G9342 L0920 S8100

54409 84083 97701 3754F C1333 D0420 G8007 G9343 L0930 S8101

54415 84090 97703 3755F C1334 D0421 G8008 G9344 L0940 S8110

54416 84118 97720 3756F C1335 D0425 G8009 G9345 L0950 S8120

54417 84121 97721 3757F C1336 D0431 G8010 G9346 L0960 S8121

54510 84128 97752 3758F C1337 D0471 G8011 G9347 L0986 S8185

54645 84136 97770 3759F C1348 D0475 G8012 G9348 L1750 S8186

54699 84139 97780 3760F C1350 D0476 G8013 G9349 L1800 S8189

54820 84141 97781 3761F C1351 D0477 G8014 G9350 L1815 S8200

55200 84142 97810 3762F C1352 D0478 G8015 G9351 L1825 S8205

55300 84147 97811 3763F C1353 D0479 G8016 G9352 L1855 S8210

55559 84149 97813 4000F C1354 D0481 G8017 G9353 L1858 S8270

55740 84170 97814 4001F C1355 D0482 G8018 G9354 L1870 S8300

55859 84175 98900 4002F C1356 D0483 G8019 G9355 L1880 S8301

55970 84176 98902 4003F C1357 D0484 G8020 G9356 L1885 S8402

55980 84180 98910 4004F C1358 D0485 G8021 G9357 L1901 S8404

56000 84185 98912 4005F C1359 D0486 G8022 G9358 L2039 S8415

56100 84190 98920 4006F C1360 D0501 G8023 G9359 L2102 S8420

56200 84195 98921 4007F C1361 D1201 G8024 G9360 L2104 S8421

56300 84200 98922 4008F C1362 D1202 G8025 H0003 L2122 S8422

56301 84201 98940 4009F C1363 D1205 G8026 H0004 L2124 S8423

56302 84205 98941 4010F C1364 D1310 G8027 H0006 L2435 S8424

56303 84208 98942 4011F C1365 D1330 G8028 H0008 L2770 S8425

56304 84230 98943 4012F C1366 D2110 G8029 H0009 L2860 S8426

56305 84231 98960 4013F C1367 D2120 G8030 H0010 L3218 S8427

56306 84232 98961 4014F C1368 D2130 G8031 H0011 L3223 S8428

56307 84236 98962 4015F C1369 D2131 G8032 H0012 L3431 S8429

56308 84246 98966 4016F C1370 D2210 G8033 H0013 L3486 S8430

56309 84310 98967 4017F C1371 D2336 G8034 H0014 L3651 S8431

56310 84318 98968 4018F C1372 D2337 G8035 H0016 L3652 S8450

56311 84324 98969 4019F C1375 D2380 G8036 H0021 L3700 S8451

56312 84395 99000 4025F C1376 D2381 G8037 H0022 L3701 S8452

56313 84405 99002 4030F C1377 D2382 G8038 H0023 L3800 S8460

56314 84406 99024 4033F C1378 D2385 G8039 H0024 L3805 S8490

56315 84407 99025 4035F C1379 D2386 G8040 H0025 L3810 S8940

56316 84408 99026 4037F C1420 D2387 G8041 H0026 L3815 S8950

56317 84409 99027 4040F C1421 D2388 G8051 H0027 L3820 S8990

56318 84410 99051 4041F C1450 D2410 G8052 H0028 L3825 S8999

56320 84420 99052 4042F C1451 D2420 G8053 H0029 L3830 S9001

56321 84434 99053 4043F C1500 D2430 G8054 H0030 L3835 S9007

56322 84435 99054 4044F C1700 D2510 G8055 H0033 L3840 S9015

56323 84444 99056 4045F C1701 D2520 G8056 H0034 L3845 S9023

56324 84447 99058 4046F C1702 D2530 G8057 H0035 L3850 S9024

56340 84448 99060 4047F C1703 D2540 G8058 H0038 L3855 S9025

56341 84455 99062 4048F C1704 D2542 G8059 H0040 L3860 S9033

56342 84465 99064 4049F C1705 D2543 G8060 H0041 L3890 S9055

56343 84472 99065 4050F C1706 D2544 G8061 H0042 L3902 S9056

56344 84474 99070 4051F C1707 D2610 G8062 H0044 L3907 S9085

56345 84476 99071 4052F C1708 D2620 G8075 H0045 L3909 S9090

56346 84483 99073 4053F C1709 D2630 G8076 H0047 L3910 S9097

56347 84555 99075 4054F C1710 D2642 G8077 H0048 L3911 S9098

56348 84565 99078 4055F C1711 D2643 G8078 H0049 L3914 S9117

56349 84570 99080 4056F C1712 D2644 G8079 H0050 L3916 S9126

56350 84575 99082 4058F C1713 D2650 G8080 H1000 L3918 S9140

56351 84584 99090 4060F C1714 D2651 G8081 H1001 L3920 S9141

56352 84589 99091 4062F C1715 D2652 G8082 H1002 L3922 S9150

56353 84595 99100 4063F C1716 D2662 G8085 H1003 L3924 S9152

56354 84605 99116 4064F C1717 D2663 G8093 H1004 L3926 S9209

56355 84610 99132 4065F C1718 D2664 G8094 H1005 L3928 S9212

56356 84613 99135 4066F C1719 D2720 G8099 H1010 L3930 S9213

56360 84615 99140 4067F C1720 D2740 G8100 H1011 L3932 S9214

56361 84635 99141 4069F C1721 D2750 G8103 H2000 L3934 S9325

56362 84695 99142 4070F C1722 D2780 G8104 H2001 L3936 S9329

56363 84800 99143 4073F C1724 D2783 G8106 H2010 L3938 S9335

56399 84810 99144 4075F C1725 D2790 G8107 H2013 L3940 S9339

56400 84830 99145 4077F C1726 D2794 G8108 H2014 L3942 S9373

56600 85000 99151 4079F C1727 D2810 G8109 H2015 L3944 S9381

56635 85005 99152 4084F C1728 D2960 G8110 H2017 L3946 S9401

56680 85012 99160 4086F C1729 D2961 G8111 H2019 L3948 S9430

56685 85021 99162 4090F C1730 D2962 G8112 H2022 L3950 S9433

56710 85022 99171 4095F C1731 D2971 G8113 H2025 L3952 S9435

56720 85023 99172 4100F C1732 D2975 G8114 H2026 L3954 S9453

57108 85024 99178 4110F C1733 D3331 G8115 H2028 L3963 S9454

57126 85029 99180 4115F C1750 D3340 G8116 H2029 L3985 S9472

57450 85030 99182 4120F C1751 D3350 G8117 H2030 L3986 S9473

57451 85031 99185 4124F C1752 D3411 G8126 H2031 L4200 S9475

57820 85095 99186 4130F C1753 D3440 G8127 H2032 L4310 S9476

58101 85100 99190 4131F C1754 D3460 G8128 H2033 L4320 S9480

58102 85101 99191 4132F C1755 D3920 G8129 H2034 L4390 S9482

58265 85102 99192 4133F C1756 D3940 G8130 H2037 L5300 S9485

58310 85103 99241 4134F C1757 D3950 G8131 H5010 L5310 S9527

58311 85105 99242 4135F C1758 D3960 G8152 H5020 L5320 S9528

58320 85109 99243 4136F C1759 D4220 G8153 H5025 L5330 S9529

58551 85171 99245 4140F C1760 D4262 G8154 H5030 L5340 S9538

58579 85172 99251 4142F C1762 D4272 G8155 H5040 L5660 S9810

58679 85242 99252 4144F C1763 D4340 G8156 H5050 L5662 S9900

58972 85310 99253 4145F C1764 D5215 G8157 H5060 L5663 S9960

58974 85311 99254 4148F C1765 D5216 G8158 H5090 L5664 S9961

58980 85320 99255 4149F C1766 D5280 G8159 H5100 L5667 S9970

58982 85330 99261 4150F C1767 D5281 G8160 H5110 L5669 S9975

58983 85340 99262 4151F C1768 D5710 G8161 H5120 L5674 S9976

58984 85341 99263 4152F C1769 D5711 G8162 H5130 L5675 S9977

58985 85363 99271 4153F C1770 D5720 G8163 H5160 L5846 S9981

58986 85364 99272 4154F C1771 D5721 G8164 H5170 L5847 S9982

58987 85365 99273 4155F C1772 D5860 G8165 H5180 L5973 S9986

58988 85367 99274 4156F C1773 D5861 G8166 H5190 L5989 S9988

58990 85368 99275 4157F C1775 D5862 G8167 H5200 L5993 S9989

58992 85369 99288 4158F C1776 D5867 G8170 H5220 L5994 S9990

58994 85371 99289 4159F C1777 D5875 G8171 H5230 L5995 S9991

58996 85372 99290 4163F C1778 D5917 G8172 H5240 L6639 S9992

58999 85374 99293 4164F C1779 D5918 G8182 H5299 L6700 S9994

59412 85376 99294 4165F C1780 D5920 G8183 H5300 L6705 S9996

59420 85377 99295 4167F C1781 D5921 G8184 J0110 L6710 S9999

59897 85392 99296 4168F C1782 D5956 G8185 J0151 L6715 T1003

59898 85395 99297 4169F C1783 D5957 G8186 J0200 L6720 T1004

59899 85398 99298 4171F C1784 D5971 G8191 J0230 L6725 T1006

60001 85426 99299 4172F C1785 D5972 G8192 J0240 L6730 T1008

60245 85535 99300 4174F C1786 D5973 G8193 J0286 L6735 T1009

60246 85538 99301 4175F C1787 D5974 G8194 J0340 L6740 T1010

60659 85544 99302 4176F C1788 D5976 G8195 J0460 L6745 T1012

60699 85548 99303 4177F C1789 D5982 G8196 J0510 L6750 T1013

61106 85556 99311 4178F C1790 D5983 G8197 J0530 L6755 T1014

61130 85560 99312 4179F C1791 D5984 G8198 J0540 L6765 T1016

61553 85575 99313 4180F C1792 D5985 G8199 J0550 L6770 T1017

61555 85577 99321 4181F C1793 D6010 G8200 J0590 L6775 T1018

61561 85580 99322 4182F C1794 D6012 G8201 J0635 L6780 T1019

61712 85585 99323 4185F C1795 D6020 G8202 J0680 L6790 T1020

61780 85590 99324 4186F C1796 D6040 G8203 J0695 L6795 T1021

61793 85595 99325 4187F C1797 D6050 G8204 J0700 L6800 T1022

61855 85615 99326 4188F C1798 D6053 G8205 J0730 L6806 T1027

61862 85618 99327 4189F C1799 D6054 G8206 J0790 L6807 T1030

61865 85630 99328 4190F C1800 D6055 G8207 J0810 L6808 T1031

62274 85632 99331 4191F C1801 D6056 G8208 J0820 L6809 T1035

62275 85650 99332 4192F C1802 D6057 G8209 J0830 L6825 T1502

62276 85665 99333 4193F C1803 D6058 G8210 J0835 L6830 T1503

62277 85667 99334 4194F C1804 D6059 G8211 J0840 L6835 T1505

62278 85680 99335 4195F C1805 D6060 G8212 J0880 L6840 T1999

62279 85700 99336 4196F C1806 D6061 G8213 J1090 L6845 T2004

62288 85710 99337 4200F C1810 D6062 G8214 J1095 L6850 T2005

62289 85711 99339 4201F C1811 D6063 G8215 J1155 L6855 T2007

62298 85720 99340 4210F C1812 D6064 G8216 J1340 L6860 T2010

63010 85820 99351 4220F C1813 D6065 G8217 J1350 L6865 T2011

63652 86002 99352 4221F C1814 D6066 G8218 J1360 L6867 T2012

63656 86004 99353 4230F C1815 D6067 G8219 J1362 L6868 T2013

63657 86006 99358 4240F C1816 D6068 G8220 J1446 L6870 T2017

63658 86007 99359 4242F C1817 D6069 G8221 J1563 L6872 T2023

63660 86008 99361 4245F C1818 D6070 G8222 J1564 L6873 T2024

63690 86009 99362 4248F C1819 D6071 G8223 J1565 L6875 T2026

63691 86011 99363 4250F C1820 D6072 G8224 J1567 L6880 T2027

63750 86012 99364 4255F C1821 D6073 G8225 J1625 L7007 T2028

63780 86013 99366 4256F C1841 D6074 G8226 J1660 L7008 T2029

64440 86014 99367 4260F C1850 D6075 G8227 J1680 L7009 T2030

64441 86016 99368 4261F C1851 D6076 G8228 J1690 L7010 T2032

64442 86019 99371 4265F C1852 D6077 G8229 J1725 L7015 T2034

64443 86024 99372 4266F C1853 D6078 G8230 J1739 L7020 T2036

64470 86027 99373 4267F C1854 D6079 G8231 J1741 L7025 T2037

64472 86031 99374 4268F C1855 D6080 G8232 J1751 L7030 T2039

64475 86032 99375 4269F C1856 D6090 G8234 J1752 L7035 T2041

64476 86033 99376 4270F C1857 D6091 G8235 J1755 L7160 T2043

64755 86034 99377 4271F C1858 D6092 G8236 J1760 L7165 T2044

64830 86064 99378 4274F C1859 D6093 G8237 J1770 L7611 T2045

65230 86066 99379 4275F C1860 D6094 G8238 J1780 L7612 T2046

65240 86067 99380 4276F C1861 D6095 G8239 J1817 L7613 T2048

65245 86068 99411 4279F C1862 D6100 G8240 J1820 L7614 T2049

65300 86070 99412 4280F C1863 D6190 G8241 J1910 L7621 T2101

65825 86078 99420 4290F C1864 D6194 G8242 J1970 L7622 T4536

65830 86079 99429 4293F C1865 D6199 G8243 J2000 L8031 T4538

66682 86080 99431 4300F C1866 D6205 G8245 J2050 L8032 T4540

66701 86082 99432 4301F C1867 D6210 G8246 J2100 L8100 T5999

66702 86083 99433 4305F C1868 D6214 G8247 J2160 L8110 V2702

66721 86084 99435 4306F C1869 D6240 G8248 J2190 L8120 V2745

66741 86085 99436 4320F C1870 D6245 G8249 J2220 L8130 V2755

66800 86095 99438 4322F C1871 D6250 G8250 J2240 L8140 V2756

66801 86100 99440 4324F C1872 D6253 G8251 J2324 L8150 V2761

66802 86105 99441 4325F C1873 D6519 G8252 J2330 L8160 V2770

66915 86115 99442 4326F C1874 D6520 G8253 J2350 L8170 V2780

67038 86128 99443 4328F C1875 D6530 G8254 J2352 L8180 V2781

67109 86130 99444 4330F C1876 D6540 G8255 J2480 L8190 V2786

67313 86149 99450 4340F C1877 D6543 G8256 J2490 L8195 V2787

67350 86151 99455 4350F C1878 D6544 G8257 J2495 L8200 V2788

67399 86158 99456 4400F C1879 D6548 G8258 J2500 L8210 V2797

67599 86159 99500 4450F C1880 D6600 G8259 J2512 L8220 V5010

67907 86163 99501 4470F C1881 D6601 G8260 J2520 L8230 V5011

68800 86164 99502 4480F C1882 D6602 G8261 J2545 L8239 V5020

68820 86244 99504 4481F C1883 D6603 G8262 J2595 L8490 V5110

68825 86265 99505 4500F C1884 D6604 G8263 J2600 L8604 V5160

68830 86266 99506 4510F C1885 D6605 G8264 J2640 L8605 V5200

69090 86267 99507 4525F C1887 D6606 G8265 J2672 L8620 V5240

69410 86281 99508 4526F C1888 D6607 G8266 J2825 L8627 V5241

69450 86282 99509 4540F C1891 D6608 G8267 J2860 L8628 V5264

69661 86283 99511 4541F C1892 D6609 G8268 J2912 L8629 V5265

70011 86287 99512 C1893 D6610 G8269 J2914 L8679 V5268

G8270 V5269

V5270

V5271

V5272

V5273

V5274

V5275

V5299

kschal1File Attachment2015B UnitedHealthcare Community Plan DELAWARE LTC Non Covered Codes.pdf

2015C UnitedHealthcare Community Plan Iowa Medicaid Non Covered Codes

11950 89251 0293T 1491F 3515F 4555F A5102 A6361 E0305 G9470

11951 89253 0294T 1493F 3550F 4556F A5105 A6362 E0310 G9471

11952 89254 0295T 1494F 3551F 4557F A5112 A6363 E0315 G9472

11953 89255 0296T 1500F 3552F 4558F A5113 A6364 E0316 H2014

11954 89257 0297T 1501F 3555F 4559F A5114 A6365 E0370 J0725

15775 89258 0298T 1502F 3570F 4560F A5126 A6366 E0446 J2170

15776 89259 0299T 1503F 3572F 4561F A5131 A6367 E0575 J2941

15780 89260 0300T 1504F 3573F 4562F A5200 A6368 E0602 J3355

15781 89261 0301T 1505F 3650F 4563F A5510 A6369 E0604 K0601

15782 89264 0302T 2000F 3700F 5005F A6000 A6370 E0605 K0602

15783 89268 0303T 2001F 3720F 5010F A6010 A6371 E0625 K0603

15784 89272 0304T 2002F 3725F 5015F A6011 A6372 E0627 K0604

15785 89280 0305T 2004F 3751F 5020F A6021 A6373 E0628 K0605

15786 89281 0306T 2010F 3752F 5050F A6022 A6374 E0629 K

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