Claim total
$99.68
base $93.39 · payer covered $49.68
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1983-10-15
- Stop
- 1983-10-15
The parties
- Patient
- patient Reatha Victor O'Conner
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
0521a0be-ba7b-b4e6-4f92-4585ee5e991c