| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 72197 |
|
334 |
333 |
$46K |
| 75574 |
|
112 |
110 |
$20K |
| 71250 |
|
190 |
189 |
$11K |
| 71046 |
Radiologic examination, chest; 2 views |
231 |
231 |
$3K |
| 74183 |
|
12 |
12 |
$1K |
| 76498 |
|
90 |
90 |
$532.21 |
| 74178 |
|
12 |
12 |
$416.19 |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
17 |
17 |
$412.47 |
| 76377 |
|
57 |
57 |
$274.04 |
| 71045 |
Radiologic examination, chest; single view |
20 |
19 |
$110.41 |
| J3490 |
Unclassified drugs |
23 |
14 |
$2.07 |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
378 |
375 |
$0.00 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
361 |
358 |
$0.00 |