| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
136 |
117 |
$23K |
| 70450 |
Computed tomography, head or brain; without contrast material |
353 |
328 |
$16K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
25 |
25 |
$2K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
38 |
36 |
$2K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
24 |
22 |
$588.53 |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
12 |
12 |
$329.94 |
| 71045 |
Radiologic examination, chest; single view |
128 |
108 |
$260.50 |
| 71046 |
Radiologic examination, chest; 2 views |
108 |
104 |
$256.96 |
| 72110 |
|
15 |
14 |
$222.13 |
| 93971 |
|
13 |
12 |
$53.85 |
| A9576 |
Injection, gadoteridol, (prohance multipack), per ml |
12 |
12 |
$9.83 |