Claim total
$333.20
base $93.39 · payer covered $283.20
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-02-25
- Stop
- 2025-02-25
The parties
- Patient
- patient Elinore Danyelle Streich
- Provider
- provider Danilo Davis
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
03b3068a-a726-461a-270c-343ad5361ccc