Claim total
$219.90
base $93.39 · payer covered $169.90
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2021-11-25
- Stop
- 2021-11-25
The parties
- Patient
- patient Terese Darla Williamson
- Provider
- provider Heriberto Smitham
- Payer
- payer Medicaid
Record id
0098424c-ec2c-0924-8155-375645192330