Claim for Ronnie Ina Gusikowski — 1970-01-23

Patient

patient Ronnie Ina Gusikowski

Visit

visit Encounter for check up

Serviced

1970-01-23illness from the same day

Status

Closedlast billed 1970-01-23 · type 2

Billed for

procedure concept prophylaxis, adultcode D1110procedure concept periodic oral evaluation, established patient · D0120

Coverage

payer Medicaid no secondary insurer

Outstanding

Nothing outstandingsettled in full