Claim total
$104.18
base $93.39 · payer covered $54.18
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2024-04-20
- Stop
- 2024-04-20
The parties
- Patient
- patient Dorotea Yolanda Palomo
- Provider
- provider Amber Yost
- Payer
- payer Medicaid
Record id
04ad2732-b952-4fbb-9ff5-a56b3eb3d996