Claim total
$133.32
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1999-05-19
- Stop
- 1999-05-19
The parties
- Patient
- patient Christel Torp
- Provider
- provider Heriberto Smitham
Record id
00edd987-99b7-13d9-5db4-2bcc1b7a956f