Claim total
$96.51
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2021-07-10
- Stop
- 2021-07-10
The parties
- Patient
- patient Dora Violet Okuneva
- Provider
- provider Heriberto Smitham
- Payer
- payer Anthem
Record id
001727b6-dbde-2493-c1b9-8f0c2ffed0cf