Claim total
$96.96
base $93.39 · payer covered $96.96
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2021-03-23
- Stop
- 2021-03-23
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Heriberto Smitham
- Payer
- payer Aetna
Record id
03f9d33d-12ca-f1a8-3cac-da44c9e511ff