| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0425 |
Ground mileage, per statute mile |
6,170 |
4,054 |
$124K |
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
17,121 |
8,311 |
$10K |
| A0380 |
Bls mileage (per mile) |
7,521 |
2,976 |
$0.00 |
| A0130 |
Non-emergency transportation: wheelchair van |
5,555 |
2,663 |
$0.00 |
| S0215 |
Non-emergency transportation; mileage, per mile |
96 |
44 |
$0.00 |
| S0209 |
Wheelchair van, mileage, per mile |
4,500 |
2,175 |
$0.00 |
| T2003 |
Non-emergency transportation; encounter/trip |
96 |
44 |
$0.00 |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
190 |
156 |
$-740.13 |