| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
23 |
23 |
$2K |
| 71045 |
Radiologic examination, chest; single view |
239 |
218 |
$2K |
| 71046 |
Radiologic examination, chest; 2 views |
125 |
123 |
$1K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
15 |
15 |
$1K |
| 70450 |
Computed tomography, head or brain; without contrast material |
12 |
12 |
$404.80 |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
14 |
14 |
$97.74 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
15 |
13 |
$50.98 |