| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
1,607 |
1,606 |
$68K |
| 76536 |
|
1,204 |
1,204 |
$47K |
| 76641 |
|
906 |
645 |
$43K |
| 71250 |
|
318 |
317 |
$15K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
41 |
41 |
$14K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
127 |
127 |
$14K |
| 93976 |
|
190 |
190 |
$12K |
| 71046 |
Radiologic examination, chest; 2 views |
861 |
860 |
$11K |
| 76775 |
|
511 |
511 |
$8K |
| 76770 |
|
98 |
98 |
$4K |
| 73562 |
|
189 |
133 |
$3K |
| 74183 |
|
17 |
17 |
$2K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
24 |
24 |
$2K |
| 72110 |
|
57 |
57 |
$1K |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
26 |
26 |
$1K |
| 77080 |
|
72 |
72 |
$981.33 |
| 72050 |
|
25 |
25 |
$513.85 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
16 |
16 |
$410.41 |
| 76857 |
|
26 |
26 |
$346.03 |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
14 |
14 |
$339.56 |
| 71045 |
Radiologic examination, chest; single view |
70 |
68 |
$262.85 |
| A9576 |
Injection, gadoteridol, (prohance multipack), per ml |
15 |
15 |
$50.90 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
16 |
16 |
$18.71 |
| 99072 |
|
80 |
79 |
$0.00 |