Claim total
$113.05
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2021-10-28
- Stop
- 2021-10-28
The parties
- Patient
- patient Salvador Hernán Marrero
- Provider
- provider Heriberto Smitham
- Payer
- payer Medicaid
Record id
003934f5-fa99-8d07-552c-db7fad223f0b