| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
3,573 |
3,566 |
$143K |
| 76536 |
|
2,577 |
2,575 |
$101K |
| 74183 |
|
701 |
700 |
$84K |
| 76641 |
|
1,555 |
1,217 |
$78K |
| 71250 |
|
1,203 |
1,203 |
$61K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
356 |
356 |
$42K |
| 93976 |
|
631 |
631 |
$35K |
| 74178 |
|
207 |
207 |
$23K |
| 71046 |
Radiologic examination, chest; 2 views |
1,711 |
1,708 |
$21K |
| 76775 |
|
795 |
791 |
$12K |
| 76770 |
|
357 |
356 |
$12K |
| 73562 |
|
654 |
439 |
$10K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
208 |
208 |
$10K |
| 72110 |
|
400 |
397 |
$7K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
191 |
191 |
$6K |
| 74170 |
|
55 |
55 |
$4K |
| 76830 |
Ultrasound, transvaginal |
67 |
67 |
$3K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
85 |
85 |
$3K |
| 76857 |
|
172 |
171 |
$2K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
25 |
25 |
$2K |
| 72050 |
|
113 |
113 |
$2K |
| A9576 |
Injection, gadoteridol, (prohance multipack), per ml |
556 |
555 |
$2K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
29 |
29 |
$1K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
12 |
12 |
$897.25 |
| 77080 |
|
72 |
72 |
$876.51 |
| 76981 |
|
27 |
27 |
$732.45 |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
15 |
15 |
$607.59 |
| 73630 |
|
73 |
59 |
$571.33 |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
42 |
42 |
$563.80 |
| 77065 |
Tomosynthesis, mammo |
15 |
15 |
$470.39 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
410 |
409 |
$347.26 |
| 73030 |
|
12 |
12 |
$314.66 |
| 73502 |
|
14 |
14 |
$112.92 |
| A9581 |
Injection, gadoxetate disodium, 1 ml |
13 |
13 |
$0.00 |
| 99072 |
|
331 |
326 |
$0.00 |