Claim total
$109.51
base $93.39 · payer covered $59.51
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1986-05-28
- Stop
- 1986-05-28
The parties
- Patient
- patient Susanna Avis Emard
- Provider
- provider Adrienne Hills
- Payer
- payer Medicaid
Record id
0443166c-c803-503e-e51c-ada557b69642