| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0425 |
Ground mileage, per statute mile |
8,023 |
1,664 |
$132K |
| S0215 |
Non-emergency transportation; mileage, per mile |
3,285 |
953 |
$88K |
| A0110 |
Non-emergency transportation and bus, intra or inter state carrier |
6,838 |
1,360 |
$69K |
| A0130 |
Non-emergency transportation: wheelchair van |
1,771 |
367 |
$8K |
| T2005 |
Non-emergency transportation; stretcher van |
86 |
13 |
$3K |
| T2049 |
Non-emergency transportation; stretcher van, mileage; per mile |
82 |
12 |
$452.40 |
| A0120 |
Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems |
3,820 |
945 |
$0.00 |