| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 74177 |
|
2,692 |
2,340 |
$371K |
| 72148 |
|
1,013 |
881 |
$84K |
| 71260 |
|
1,081 |
935 |
$81K |
| 73721 |
|
352 |
309 |
$39K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
5,506 |
4,573 |
$37K |
| A9585 |
Gadobutrol injection |
1,636 |
1,027 |
$23K |
| 74176 |
|
205 |
174 |
$21K |
| 77002 |
|
402 |
323 |
$20K |
| 73221 |
|
94 |
79 |
$12K |
| 71250 |
|
164 |
142 |
$12K |
| Q9965 |
Locm 100-199mg/ml iodine,1ml |
2,803 |
1,231 |
$12K |
| 72141 |
|
96 |
90 |
$10K |
| 76705 |
|
189 |
175 |
$9K |
| 62323 |
|
26 |
26 |
$4K |
| J1040 |
Methylprednisolone 80 mg inj |
287 |
240 |
$2K |
| 20610 |
|
44 |
42 |
$1K |
| 76536 |
|
15 |
15 |
$1K |
| 93971 |
|
15 |
12 |
$1K |
| 76770 |
|
16 |
12 |
$822.90 |
| J3301 |
Triamcinolone acet inj nos |
65 |
59 |
$296.28 |
| J1010 |
Inj, methylpred acetate 1 mg |
15 |
12 |
$136.79 |
| J1030 |
Methylprednisolone 40 mg inj |
12 |
12 |
$75.00 |
| J1100 |
Dexamethasone sodium phos |
40 |
29 |
$18.89 |
| G9551 |
Imag no les |
46 |
41 |
$0.00 |
| G9327 |
Ct done rad ds index |
146 |
103 |
$0.00 |
| G9756 |
Surg proc w/silicone oil |
35 |
28 |
$0.00 |
| G9637 |
Doc >1 dose reduc tech |
165 |
124 |
$0.00 |
| G9557 |
Ct/cta/mri/a no thyr <1.0cm |
17 |
14 |
$0.00 |