| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
557 |
487 |
$49K |
| 76641 |
|
372 |
249 |
$17K |
| 0011A |
|
405 |
359 |
$15K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
291 |
225 |
$14K |
| 70450 |
Computed tomography, head or brain; without contrast material |
241 |
217 |
$14K |
| 76830 |
Ultrasound, transvaginal |
214 |
181 |
$12K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
664 |
325 |
$12K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
112 |
90 |
$11K |
| 0002A |
|
214 |
195 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
133 |
130 |
$7K |
| 77066 |
Tomosynthesis, mammo |
213 |
107 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
894 |
776 |
$6K |
| 0012A |
|
224 |
208 |
$5K |
| 0001A |
|
148 |
129 |
$4K |
| 72100 |
|
365 |
309 |
$3K |
| 71046 |
Radiologic examination, chest; 2 views |
524 |
438 |
$3K |
| 76536 |
|
56 |
47 |
$2K |
| 72040 |
|
253 |
217 |
$2K |
| 73560 |
|
223 |
188 |
$2K |
| 71045 |
Radiologic examination, chest; single view |
303 |
250 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
180 |
149 |
$2K |
| 73030 |
|
223 |
186 |
$2K |
| 74019 |
|
233 |
193 |
$2K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
31 |
26 |
$1K |
| 74018 |
|
236 |
190 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
29 |
29 |
$1K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
20 |
16 |
$1K |
| 73600 |
|
183 |
148 |
$1K |
| 99051 |
|
13 |
13 |
$1K |
| 70250 |
|
134 |
113 |
$1K |
| 0003A |
|
14 |
14 |
$560.00 |
| 73620 |
|
67 |
59 |
$533.59 |
| 73630 |
|
56 |
42 |
$378.55 |
| 73120 |
|
53 |
47 |
$335.90 |
| 73070 |
|
38 |
26 |
$298.91 |
| 73100 |
|
30 |
29 |
$269.99 |
| 77080 |
|
12 |
12 |
$244.74 |
| 73140 |
|
26 |
26 |
$166.08 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
14 |
$109.50 |
| 90688 |
|
82 |
76 |
$37.54 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
310 |
237 |
$0.00 |
| 91300 |
|
503 |
420 |
$0.00 |
| 90649 |
|
90 |
83 |
$0.00 |
| 90734 |
|
12 |
12 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
16 |
16 |
$0.00 |
| 90733 |
|
15 |
13 |
$0.00 |
| 91301 |
|
628 |
564 |
$0.00 |