Claim total
$174.18
base $93.39 · payer covered $124.18
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-01-01
- Stop
- 2025-01-01
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-c981-6fa985a2ad87