| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0215 |
Non-emergency transportation; mileage, per mile |
2,931 |
414 |
$81K |
| A0425 |
Ground mileage, per statute mile |
2,265 |
617 |
$46K |
| A0110 |
Non-emergency transportation and bus, intra or inter state carrier |
3,476 |
699 |
$14K |
| T2005 |
Non-emergency transportation; stretcher van |
239 |
57 |
$6K |
| A0100 |
Non-emergency transportation; taxi |
2,222 |
288 |
$3K |
| T2049 |
Non-emergency transportation; stretcher van, mileage; per mile |
239 |
57 |
$2K |
| A0130 |
Non-emergency transportation: wheelchair van |
124 |
26 |
$540.00 |