| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 71250 |
|
1,613 |
1,608 |
$81K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
1,795 |
1,794 |
$76K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
1,054 |
1,048 |
$61K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
612 |
611 |
$60K |
| 76536 |
|
948 |
948 |
$39K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
609 |
606 |
$35K |
| 71046 |
Radiologic examination, chest; 2 views |
2,183 |
2,177 |
$32K |
| 73562 |
|
1,080 |
702 |
$19K |
| 72110 |
|
679 |
679 |
$14K |
| 70450 |
Computed tomography, head or brain; without contrast material |
175 |
175 |
$7K |
| 76775 |
|
477 |
477 |
$7K |
| 93976 |
|
82 |
82 |
$6K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
82 |
69 |
$5K |
| 72050 |
|
231 |
231 |
$4K |
| A9576 |
Injection, gadoteridol, (prohance multipack), per ml |
980 |
961 |
$3K |
| 72141 |
|
39 |
39 |
$2K |
| 76641 |
|
19 |
12 |
$1K |
| 73030 |
|
61 |
54 |
$1K |
| 75574 |
|
12 |
12 |
$966.36 |
| 74183 |
|
12 |
12 |
$909.06 |
| 73630 |
|
83 |
56 |
$899.43 |
| 73221 |
|
12 |
12 |
$597.59 |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
16 |
16 |
$596.53 |
| 76857 |
|
12 |
12 |
$292.01 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
29 |
29 |
$20.16 |
| 99072 |
|
325 |
319 |
$0.00 |