Claim total
$112.26
base $93.39 · payer covered $62.26
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2020-11-19
- Stop
- 2020-11-19
The parties
- Patient
- patient Terese Darla Williamson
- Provider
- provider Heriberto Smitham
- Payer
- payer Medicaid
Record id
0098424c-ec2c-0924-b740-704f20396115