Claim total
$191.79
base $93.39 · payer covered $141.79
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2018-09-05
- Stop
- 2018-09-05
The parties
- Patient
- patient Adam Alfonzo Stokes
- Provider
- provider Enoch Torp
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
056ed411-c295-a5c9-2e15-4b33f7b51264