| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 71045 |
Radiologic examination, chest; single view |
725 |
672 |
$6K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
24 |
24 |
$2K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
33 |
26 |
$671.64 |
| 70450 |
Computed tomography, head or brain; without contrast material |
25 |
25 |
$440.57 |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
12 |
12 |
$175.90 |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
13 |
13 |
$166.40 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
12 |
12 |
$19.80 |