Claim for Xuan Collier — 2015-06-07

Patient

patient Xuan Collier

Visit

visit Encounter for check up

Serviced

2015-06-07illness from the same day

Status

Closedlast billed 2015-06-07 · type 2

Billed for

procedure concept bitewings, four radiographic imagescode D0274procedure concept periodic oral evaluation, established patient · D0120procedure concept sealant, per tooth · D1351

Coverage

payer Humana no secondary insurer

Outstanding

Nothing outstandingsettled in full