Claim total
$169.28
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2019-07-06
- Stop
- 2019-07-06
The parties
- Patient
- patient Dora Violet Okuneva
- Provider
- provider Heriberto Smitham
- Payer
- payer Anthem
Record id
001727b6-dbde-2493-dce6-ab4d43235011