Claim total
$179.15
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2021-11-03
- Stop
- 2021-11-03
The parties
- Patient
- patient Sha Robin Reilly
- Provider
- provider Amber Yost
- Payer
- payer No insurance
Record id
043d6e13-0cc7-07f3-c4e7-e4894327d8a1