| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 36902 |
|
1,245 |
1,223 |
$424K |
| 36215 |
|
342 |
324 |
$76K |
| 36907 |
|
508 |
496 |
$57K |
| 75710 |
|
814 |
767 |
$37K |
| 99152 |
|
1,614 |
1,556 |
$18K |
| 37252 |
|
15 |
14 |
$3K |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
1,079 |
1,030 |
$1K |
| 37253 |
|
16 |
15 |
$572.76 |
| 71045 |
Radiologic examination, chest; single view |
55 |
45 |
$149.33 |
| 71046 |
Radiologic examination, chest; 2 views |
14 |
13 |
$48.74 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
940 |
903 |
$32.79 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
996 |
953 |
$5.49 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
25 |
12 |
$0.00 |