Claim total
$268.84
base $93.39 · payer covered $218.84
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2010-05-05
- Stop
- 2010-05-05
The parties
- Patient
- patient Miles Auer
- Provider
- provider Boris Lynch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
02b37b89-9593-6a10-0a3c-47abf356da68