| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
1,440 |
1,153 |
$245K |
| A0425 |
Ground mileage, per statute mile |
1,440 |
1,153 |
$78K |
| A0130 |
Non-emergency transportation: wheelchair van |
2,739 |
2,594 |
$52K |
| S0209 |
Wheelchair van, mileage, per mile |
2,741 |
2,596 |
$35K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
52 |
50 |
$7K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
14 |
14 |
$3K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
16 |
15 |
$3K |
| T2003 |
Non-emergency transportation; encounter/trip |
140 |
134 |
$1K |
| S0215 |
Non-emergency transportation; mileage, per mile |
140 |
134 |
$732.09 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
37 |
29 |
$150.13 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
45 |
38 |
$140.58 |
| 85027 |
|
37 |
31 |
$74.63 |
| 84484 |
|
16 |
12 |
$0.00 |