Claim total
$96.22
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2023-04-04
- Stop
- 2023-04-04
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Heriberto Smitham
- Payer
- payer Aetna
Record id
03f9d33d-12ca-f1a8-cb15-f06db70ec9d2