Claim total
$227.96
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1999-10-27
- Stop
- 1999-10-27
The parties
- Patient
- patient Carolee Shenna Franecki
- Provider
- provider Heriberto Smitham
- Payer
- payer No insurance
Record id
05da998f-3dd0-aeca-f506-040920d8f36b