Claim total
$110.75
base $93.39 · payer covered $60.75
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2004-12-25
- Stop
- 2004-12-25
The parties
- Patient
- patient Bradford Bennie Klein
- Provider
- provider Dorethea Predovic
- Care site
- care site ALTRU HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
01bbe7d1-151b-3eec-e5ac-6c6dc215acbf