Claim total
$145.92
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2023-12-07
- Stop
- 2023-12-07
The parties
- Patient
- patient Terese Darla Williamson
- Provider
- provider Heriberto Smitham
- Payer
- payer Medicaid
Record id
0098424c-ec2c-0924-3bb1-abe327a2da2c