Claim total
$209.42
base $93.39 · payer covered $159.42
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2018-10-30
- Stop
- 2018-10-30
The parties
- Patient
- patient Mirta Nakisha Franecki
- Provider
- provider Amber Yost
- Payer
- payer Medicaid
Record id
05902870-85f1-fda1-56fe-45a99c70fc53