Claim total
$170.91
base $93.39 · payer covered $120.91
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2018-04-03
- Stop
- 2018-04-03
The parties
- Patient
- patient Cleo Timothy Kemmer
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
04d0e486-8d5f-7bad-6c38-565dbf348823