Claim total
$110.65
base $93.39 · payer covered $60.65
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2018-05-20
- Stop
- 2018-05-20
The parties
- Provider
- provider Heriberto Smitham
- Payer
- payer Medicaid
Record id
014b9cfb-a71a-d032-5cec-eefab55275ea