Claim total
$607.27
base $93.39 · payer covered $557.27
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1987-06-03
- Stop
- 1987-06-03
The parties
- Patient
- patient Susanna Avis Emard
- Provider
- provider Adrienne Hills
- Payer
- payer Medicaid
Record id
0443166c-c803-503e-4ce8-790823160190