| Code | Description | Claims | Beneficiaries | Total Paid |
| A0130 |
Non-emergency transportation: wheelchair van |
9,607 |
1,726 |
$229K |
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
4,953 |
1,942 |
$229K |
| A0425 |
Ground mileage, per statute mile |
6,827 |
3,319 |
$118K |
| S0209 |
Wheelchair van, mileage, per mile |
9,576 |
1,720 |
$99K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
934 |
823 |
$72K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
308 |
285 |
$26K |
| A0426 |
Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) |
96 |
58 |
$4K |