Claim total
$101.25
base $93.39 · payer covered $51.25
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2021-05-29
- Stop
- 2021-05-29
The parties
- Patient
- patient Belva Nadene Kuphal
- Provider
- provider Josh Stamm
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
0430ce7c-cb64-da75-0476-7232334feb75