Charged
$103.66
$103.66 paid
The claim
- Patient
- patient Ronnie Ina Gusikowski
- Serviced
- 1976-07-02illness from the same day
- Status
- Closedlast billed 1976-07-02 · type 2
- Diagnoses
- diagnosis concept Gingivitiscode 66383009
- Billed for
- procedure concept periodic orthodontic treatment visitcode D8670
Settlement
- Coverage
- payer Medicaid no secondary insurer
- Outstanding
- Nothing outstandingsettled in full
Record id
003b30a0-7fd2-f42c-2d58-c279be0a0dee