Claim total
$138.75
base $93.39 · payer covered $88.75
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2025-01-27
- Stop
- 2025-01-27
The parties
- Patient
- patient Nana Earlean Kuphal
- Provider
- provider Heriberto Smitham
- Payer
- payer Medicaid
Record id
01077a3b-80bd-4b83-084b-17dbe9ac9b9b