Claim total
$104.65
base $93.39 · payer covered $54.65
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2025-10-23
- Stop
- 2025-10-23
The parties
- Patient
- patient Johnnie Rashad Pfeffer
- Provider
- provider Mario Wilkinson
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
030fbd6c-bbe4-c142-83ff-ae9486de0728