Claim total
$95.28
base $93.39 · payer covered $45.28
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2003-11-04
- Stop
- 2003-11-04
The parties
- Patient
- patient Queen Sharika Fay
- Provider
- provider Ines Kautzer
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
02c148c0-182c-a5fd-0608-81588093b1c9