Claim total
$518.92
base $93.39 · payer covered $468.92
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2019-11-11
- Stop
- 2019-11-11
The parties
- Patient
- patient Nana Earlean Kuphal
- Provider
- provider Heriberto Smitham
- Payer
- payer Medicaid
Record id
01077a3b-80bd-4b83-c71f-ba8c3022e32a