Claim total
$432.93
base $93.39 · payer covered $382.93
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2022-04-19
- Stop
- 2022-04-19
The parties
- Patient
- patient An Wenona Rau
- Provider
- provider Edmond Bauch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
04682680-f77d-0a00-e9c4-14f4146a715c