Claim total
$261.32
base $93.39 · payer covered $211.32
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1974-03-01
- Stop
- 1974-03-01
The parties
- Patient
- patient Arthur Pablo Greenfelder
- Provider
- provider Hassie Beer
- Payer
- payer Medicaid
Record id
028512d5-49bb-87e7-cf76-a37cd8ec18d5