Claim total
$96.82
base $93.39 · payer covered $46.82
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2021-08-07
- Stop
- 2021-08-07
The parties
- Patient
- patient Dorotea Yolanda Palomo
- Provider
- provider Amber Yost
- Payer
- payer Medicaid
Record id
04ad2732-b952-4fbb-d0b1-6ccd12ec05f8