Claim total
$95.93
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2024-03-07
- Stop
- 2024-03-07
The parties
- Patient
- patient Britany Kerrie West
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
02a95708-afbd-de6b-aaff-567ef21ed079