Claim total
$104.24
base $93.39 · payer covered $54.24
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1983-01-26
- Stop
- 1983-01-26
The parties
- Patient
- patient Susanna Avis Emard
- Provider
- provider Hassie Beer
- Payer
- payer Medicaid
Record id
0443166c-c803-503e-7001-7906aa160798