| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 73630 |
|
282 |
253 |
$3K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
54 |
54 |
$3K |
| 71045 |
Radiologic examination, chest; single view |
470 |
446 |
$2K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
43 |
40 |
$2K |
| 71046 |
Radiologic examination, chest; 2 views |
278 |
271 |
$2K |
| 76536 |
|
45 |
45 |
$1K |
| 73610 |
|
82 |
75 |
$1K |
| 73110 |
|
89 |
82 |
$1K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
38 |
38 |
$745.62 |
| 73130 |
|
26 |
26 |
$285.81 |
| 73030 |
|
28 |
26 |
$239.54 |
| 73562 |
|
16 |
12 |
$189.21 |
| 73502 |
|
14 |
14 |
$63.38 |