Claim total
$102.30
base $93.39 · payer covered $52.30
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2021-08-03
- Stop
- 2021-08-03
The parties
- Patient
- patient Annamarie Mollie Hoppe
- Provider
- provider Amber Yost
- Payer
- payer Medicaid
Record id
0555f11c-c453-57eb-95d2-44430d379311