Claim total
$114.83
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-12-28
- Stop
- 2025-12-28
The parties
- Patient
- patient Danyell Anya Gislason
- Provider
- provider Mario Wilkinson
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
00b8faa9-dae2-fa2d-b684-1325bc63906d