Claim total
$9,151.74
base $127.17 · payer covered $9,101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 1990-08-14
- Stop
- 1990-08-14
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-df90-397e28a4c34a