Claim total
$124.22
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2019-03-12
- Stop
- 2019-03-13
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Heriberto Smitham
- Payer
- payer Aetna
Record id
03f9d33d-12ca-f1a8-b8eb-0c649d5c71b8