Claim total
$121.86
base $93.39 · payer covered $97.49
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2021-10-10
- Stop
- 2021-10-10
The parties
- Patient
- patient Tawanna Nedra Kuhlman
- Provider
- provider Enoch Torp
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer UnitedHealthcare
Record id
00508659-1210-a7fa-748b-440de3041f7d