Claim total
$233.42
base $93.39 · payer covered $183.42
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1996-09-02
- Stop
- 1996-09-02
The parties
- Patient
- patient Nana Earlean Kuphal
- Provider
- provider Heriberto Smitham
- Payer
- payer Medicaid
Record id
01077a3b-80bd-4b83-4df7-0bbc217a108b