Claim total
$591.64
base $93.39 · payer covered $541.64
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1991-10-18
- Stop
- 1991-10-18
The parties
- Patient
- patient Wilson Teodoro Kihn
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
04540647-5ff4-de4a-f7ec-89f8030a5e7e