| Code | Description | Claims | Beneficiaries | Total Paid |
| A0425 |
Ground mileage, per statute mile |
2,270 |
1,611 |
$115K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
833 |
652 |
$104K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
439 |
344 |
$43K |
| A0398 |
Als routine disposable supplies |
479 |
348 |
$3K |
| A0382 |
Bls routine disposable supplies |
246 |
165 |
$1K |
| A0422 |
Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation |
28 |
26 |
$137.22 |