Claim total
$95.75
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2026-08-13
- Stop
- 2026-08-13
The parties
- Patient
- patient Felicitas Lilla White
- Provider
- provider Miyoko Botsford
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Cigna Health
Record id
009a994d-1397-364c-b15b-68b63af678a0