| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
1,605 |
1,306 |
$120K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
1,237 |
1,005 |
$120K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
148 |
120 |
$27K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
45 |
37 |
$16K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
2,691 |
1,666 |
$15K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
1,830 |
1,495 |
$11K |
| 80053 |
Comprehensive metabolic panel |
638 |
400 |
$4K |
| A9585 |
Injection, gadobutrol, 0.1 ml |
122 |
101 |
$2K |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
17 |
12 |
$1K |
| A9578 |
Injection, gadobenate dimeglumine (multihance multipack), per ml |
70 |
60 |
$1K |
| 82728 |
|
17 |
12 |
$214.33 |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
21 |
14 |
$185.60 |
| 83550 |
|
12 |
12 |
$70.44 |
| 83540 |
|
12 |
12 |
$52.16 |