| DJB20802BP... | DJBLORIB21... | 1 | | Q513: Orthopedic Services | ($1,700.00) | 2009 | 20617966 |
| DJB20802BP... | DJBLORIB21... | 0 | | Q513: Orthopedic Services | $500.00 | 2009 | 20703176 |
| DJB20802BP... | DJBLORIB21... | 0 | | Q513: Orthopedic Services | $5,000.00 | 2009 | 20784495 |
| DJB20802BP... | DJBLORIB21... | 1 | | Q513: Orthopedic Services | ($1,425.00) | 2009 | 20863835 |
| DJBP0208IB... | 0 | | Q999: Other Medical Services | $610.00 | 2009 | 20965190 |
| DJB20802BP... | DJBLORIB21... | 0 | | Q513: Orthopedic Services | $500.00 | 2009 | 20994787 |
| DJB20802BP... | DJBLORIB21... | 1 | | Q513: Orthopedic Services | ($4,537.00) | 2009 | 21049280 |
| DJBP0208IB... | 0 | | Q999: Other Medical Services | $63.00 | 2009 | 21081777 |
| DJB20802BP... | DJBLORIB21... | 1 | | Q513: Orthopedic Services | ($160.00) | 2009 | 21120349 |
| DJBP0208IB... | 0 | | Q999: Other Medical Services | $75.00 | 2009 | 21273987 |
| DJBP0208IB... | 0 | | Q999: Other Medical Services | $63.00 | 2009 | 21352412 |