Claim total
$103.66
base $93.39 · payer covered $53.66
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1976-07-02
- Stop
- 1976-07-02
The parties
- Patient
- patient Ronnie Ina Gusikowski
- Provider
- provider Earle Keeling
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
003b30a0-7fd2-f42c-0c26-64ddb4c354a4