| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
1,011 |
981 |
$118K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
417 |
417 |
$104K |
| 76830 |
Ultrasound, transvaginal |
154 |
154 |
$18K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
153 |
153 |
$18K |
| 71250 |
|
188 |
188 |
$18K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
128 |
127 |
$17K |
| 71046 |
Radiologic examination, chest; 2 views |
490 |
489 |
$11K |
| 73562 |
|
325 |
288 |
$11K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
44 |
44 |
$6K |
| 73630 |
|
210 |
191 |
$6K |
| 74183 |
|
16 |
16 |
$4K |
| 76641 |
|
52 |
40 |
$4K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
41 |
37 |
$4K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
31 |
31 |
$3K |
| 73610 |
|
56 |
52 |
$2K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
12 |
12 |
$2K |
| 73030 |
|
69 |
64 |
$1K |
| 76770 |
|
14 |
14 |
$954.74 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
43 |
30 |
$474.27 |
| 76536 |
|
15 |
15 |
$409.65 |
| 73110 |
|
12 |
12 |
$314.22 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
139 |
136 |
$191.12 |