Claim total
$358.14
base $93.39 · payer covered $250.69
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2017-09-22
- Stop
- 2017-09-22
The parties
- Patient
- patient Edythe Nga Pacocha
- Provider
- provider Amber Yost
Record id
00cb11fd-f3f7-0950-2622-c37be24de0c9