| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0390 |
Als mileage (per mile) |
131 |
121 |
$44K |
| A0380 |
Bls mileage (per mile) |
164 |
147 |
$37K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
108 |
88 |
$17K |
| A0425 |
Ground mileage, per statute mile |
153 |
116 |
$17K |
| A0426 |
Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) |
112 |
93 |
$12K |
| A0398 |
Als routine disposable supplies |
116 |
107 |
$11K |
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
120 |
96 |
$11K |
| A0382 |
Bls routine disposable supplies |
67 |
55 |
$6K |