Claim total
$95.79
base $93.39 · payer covered $45.79
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2024-03-26
- Stop
- 2024-03-26
The parties
- Patient
- patient Louella Roberts
- Provider
- provider Amber Yost
- Payer
- payer Medicaid
Record id
05092f50-4c35-2d72-d096-ff39f4b686d7