Claim total
$187.65
base $93.39 · payer covered $137.65
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2011-06-05
- Stop
- 2011-06-05
The parties
- Patient
- patient Terrance Raymon Kuhic
- Provider
- provider Morton Boyer
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
03e733d5-721a-3740-8e4e-44fa473863ea