Claim total
$183.54
base $93.39 · payer covered $133.54
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2021-12-08
- Stop
- 2021-12-08
The parties
- Patient
- patient Joe Maximo Kozey
- Provider
- provider Jong King
- Care site
- care site MERCY HOSPITAL
- Payer
- payer Medicaid
Record id
0135e6bd-cd4d-6318-9308-3459767b4707