Claim total
$212.09
base $93.39 · payer covered $62.09
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1986-04-21
- Stop
- 1986-04-21
The parties
- Patient
- patient Adam Jones
- Provider
- provider Damien Mante
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
00229130-e769-8779-9935-da3ea4a112ce