| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0130 |
Non-emergency transportation: wheelchair van |
7,385 |
891 |
$511K |
| T2003 |
Non-emergency transportation; encounter/trip |
12,449 |
1,268 |
$451K |
| A0120 |
Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems |
2,196 |
167 |
$193K |
| T2005 |
Non-emergency transportation; stretcher van |
123 |
54 |
$51K |
| S0215 |
Non-emergency transportation; mileage, per mile |
164 |
83 |
$636.55 |
| T2049 |
Non-emergency transportation; stretcher van, mileage; per mile |
123 |
54 |
$92.68 |