| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0425 |
Ground mileage, per statute mile |
627 |
318 |
$17K |
| A0398 |
Als routine disposable supplies |
62 |
57 |
$11K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
154 |
138 |
$10K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
94 |
81 |
$5K |
| A0422 |
Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation |
16 |
13 |
$146.00 |
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
281 |
59 |
$50.21 |