| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2005 |
Non-emergency transportation; stretcher van |
1,611 |
1,544 |
$230K |
| S0215 |
Non-emergency transportation; mileage, per mile |
4,672 |
4,135 |
$119K |
| T2049 |
Non-emergency transportation; stretcher van, mileage; per mile |
1,551 |
1,497 |
$49K |
| A0120 |
Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems |
4,755 |
4,200 |
$49K |
| T2007 |
Transportation waiting time, air ambulance and non-emergency vehicle, one-half (1/2) hour increments |
2,864 |
2,609 |
$27K |
| A0130 |
Non-emergency transportation: wheelchair van |
64 |
36 |
$1K |
| S0209 |
Wheelchair van, mileage, per mile |
62 |
33 |
$933.24 |