Claim total
$102.21
base $93.39 · payer covered $52.21
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2025-02-15
- Stop
- 2025-02-15
The parties
- Provider
- provider Antonietta Purdy
- Payer
- payer Medicaid
Record id
03d1ce86-efe3-018d-d26c-18fc259eb1e1