Claim total
$125.11
base $93.39 · payer covered $75.11
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2022-02-05
- Stop
- 2022-02-05
The parties
- Patient
- patient Tyrone Gerry Nolan
- Provider
- provider Jonas Pouros
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
0372df5d-1b51-df61-45a0-c9bc2fd43d24