I redited since it messed up chart. You don't have to worry about T,
in this particular problem.

G L M S U
Claim Code R. Code Paid Reason Code
2308 v7.23 3802 $49.99
2308 v7.23 3802 $29.99 D
2308 v7.23 3809 $33.00
2816 v7.23 3809 $96.00
2917 v8.07 5039 $57.35 D
2917 v8.07 5039 $93.18
2917 v8.07 5039 $63.07 D