Claim total
$119.01
base $93.39 · payer covered $69.01
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2022-07-07
- Stop
- 2022-07-07
The parties
- Patient
- patient Cathryn Kandy Smith
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
038ad96a-9908-2f0d-d996-a0597d727955