| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
81 |
64 |
$11K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
56 |
56 |
$6K |
| 72141 |
|
17 |
13 |
$2K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
56 |
56 |
$2K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
16 |
12 |
$2K |
| 71046 |
Radiologic examination, chest; 2 views |
113 |
104 |
$1K |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
121 |
90 |
$1K |
| 76536 |
|
16 |
12 |
$359.88 |
| 73030 |
|
13 |
13 |
$201.70 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
28 |
25 |
$43.91 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
13 |
12 |
$0.00 |
| G9737 |
Patient unable to complete the elbow/wrist/hand fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
15 |
14 |
$0.00 |