Claim total
$93.62
base $93.39 · payer covered $43.62
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1984-05-16
- Stop
- 1984-05-16
The parties
- Patient
- patient Susanna Avis Emard
- Provider
- provider Michael Dibbert
- Payer
- payer Medicaid
Record id
0443166c-c803-503e-3264-5f417f9a0bb3