| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
132 |
95 |
$3K |
| 71045 |
Radiologic examination, chest; single view |
555 |
293 |
$2K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
18 |
15 |
$2K |
| 70450 |
Computed tomography, head or brain; without contrast material |
169 |
110 |
$1K |
| 71046 |
Radiologic examination, chest; 2 views |
256 |
199 |
$764.53 |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
42 |
31 |
$467.50 |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
15 |
12 |
$179.83 |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
19 |
12 |
$11.16 |