Claim total
$126.05
base $93.39 · payer covered $76.05
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2020-10-27
- Stop
- 2020-10-27
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Charlie Tillman
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-462b-5e789c1aaf6e