Claim total
$118.67
base $93.39 · payer covered $94.93
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2025-04-15
- Stop
- 2025-04-16
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Heriberto Smitham
- Payer
- payer Anthem
Record id
03f9d33d-12ca-f1a8-05be-f486c58027f9