Claim total
$116.92
base $93.39 · payer covered $66.92
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2021-04-02
- Stop
- 2021-04-02
The parties
- Patient
- patient Wilson Teodoro Kihn
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
04540647-5ff4-de4a-7d5e-b9c02713152f