| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 74183 |
|
1,272 |
1,272 |
$139K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
2,010 |
2,010 |
$80K |
| 71250 |
|
1,280 |
1,279 |
$60K |
| 76536 |
|
1,253 |
1,253 |
$46K |
| 76641 |
|
944 |
672 |
$40K |
| 74178 |
|
228 |
228 |
$21K |
| 71046 |
Radiologic examination, chest; 2 views |
1,242 |
1,241 |
$15K |
| 76775 |
|
493 |
493 |
$7K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
55 |
55 |
$7K |
| 93976 |
|
112 |
112 |
$7K |
| 73562 |
|
400 |
283 |
$6K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
14 |
14 |
$4K |
| A9576 |
Injection, gadoteridol, (prohance multipack), per ml |
920 |
918 |
$3K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
53 |
49 |
$3K |
| 72110 |
|
177 |
177 |
$2K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
37 |
37 |
$2K |
| 76770 |
|
49 |
49 |
$2K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
25 |
25 |
$1K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
18 |
18 |
$973.48 |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
13 |
13 |
$883.93 |
| 74170 |
|
12 |
12 |
$749.42 |
| 72050 |
|
26 |
26 |
$587.75 |
| 77080 |
|
17 |
17 |
$222.96 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
350 |
350 |
$207.14 |
| 76857 |
|
12 |
12 |
$199.17 |
| 99072 |
|
282 |
278 |
$0.00 |
| A9581 |
Injection, gadoxetate disodium, 1 ml |
28 |
28 |
$0.00 |