Claim total
$476.25
base $93.39 · payer covered $426.25
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2019-01-12
- Stop
- 2019-01-12
The parties
- Provider
- provider Antonietta Purdy
- Payer
- payer Medicaid
Record id
03d1ce86-efe3-018d-555f-1ba060294c3c