Claim total
$166.51
base $93.39 · payer covered $116.51
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2022-12-14
- Stop
- 2022-12-14
The parties
- Patient
- patient Joe Maximo Kozey
- Provider
- provider Jong King
- Care site
- care site MERCY HOSPITAL
- Payer
- payer Medicaid
Record id
0135e6bd-cd4d-6318-27db-b0456fed74af