| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76801 |
|
22 |
22 |
$928.71 |
| 70450 |
Computed tomography, head or brain; without contrast material |
14 |
14 |
$877.71 |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
16 |
16 |
$783.64 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
20 |
15 |
$650.28 |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
15 |
15 |
$645.53 |
| 74018 |
|
40 |
40 |
$592.46 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
16 |
16 |
$559.44 |
| 73562 |
|
13 |
13 |
$207.92 |
| 71045 |
Radiologic examination, chest; single view |
15 |
15 |
$180.87 |