Claim total
$127.12
base $93.39 · payer covered $77.12
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2023-12-28
- Stop
- 2023-12-28
The parties
- Provider
- provider Antonetta Lubowitz
- Payer
- payer Medicaid
Record id
04dc5210-87cc-ee45-907d-514a868d1508