Claim total
$95.80
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1985-03-19
- Stop
- 1985-03-19
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Heriberto Smitham
- Payer
- payer No insurance
Record id
03f9d33d-12ca-f1a8-a4ea-1a6593982871