Claim total
$95.06
base $93.39 · payer covered $45.06
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2021-05-01
- Stop
- 2021-05-01
The parties
- Patient
- patient Shalon Arnetta Bosco
- Provider
- provider Pamula Dare
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
03f768f4-038d-f7fd-4a66-d93630486c4c