| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2003 |
Non-emergency transportation; encounter/trip |
5,229 |
731 |
$353K |
| A0130 |
Non-emergency transportation: wheelchair van |
2,231 |
586 |
$198K |
| T2005 |
Non-emergency transportation; stretcher van |
415 |
145 |
$172K |
| S0215 |
Non-emergency transportation; mileage, per mile |
125 |
43 |
$6K |
| T2049 |
Non-emergency transportation; stretcher van, mileage; per mile |
415 |
145 |
$5K |
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
52 |
24 |
$3K |
| A0120 |
Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems |
29 |
12 |
$2K |
| A0425 |
Ground mileage, per statute mile |
52 |
24 |
$0.00 |