| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0215 |
Non-emergency transportation; mileage, per mile |
6,256 |
1,458 |
$428K |
| A0425 |
Ground mileage, per statute mile |
7,057 |
1,715 |
$171K |
| A0100 |
Non-emergency transportation; taxi |
8,058 |
1,620 |
$31K |
| A0110 |
Non-emergency transportation and bus, intra or inter state carrier |
8,896 |
1,803 |
$18K |
| T2005 |
Non-emergency transportation; stretcher van |
195 |
43 |
$12K |
| T2049 |
Non-emergency transportation; stretcher van, mileage; per mile |
195 |
43 |
$4K |
| A0130 |
Non-emergency transportation: wheelchair van |
40 |
19 |
$900.00 |