Claim total
$169.68
base $93.39 · payer covered $119.68
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2006-05-16
- Stop
- 2006-05-16
The parties
- Patient
- patient Louella Roberts
- Provider
- provider Amber Yost
- Payer
- payer Medicaid
Record id
05092f50-4c35-2d72-6a08-69be1999f3ff