Claim total
$127.70
base $93.39 · payer covered $77.70
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2004-12-29
- Stop
- 2004-12-29
The parties
- Patient
- patient Cedrick Heath Rosenbaum
- Provider
- provider Jong King
- Care site
- care site MERCY HOSPITAL
- Payer
- payer Medicaid
Record id
03eafe4d-23cd-eb61-7a75-d58c90905a66