Claim total
$105.03
base $93.39 · payer covered $55.03
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2025-05-13
- Stop
- 2025-05-13
The parties
- Patient
- patient Nicky Kristi Wiegand
- Provider
- provider Silvana Weber
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
0358d022-e88b-b208-824f-7550ca267749