Claim total
$169.42
base $93.39 · payer covered $119.42
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-08-12
- Stop
- 2025-08-12
The parties
- Patient
- patient Annamarie Mollie Hoppe
- Provider
- provider Amber Yost
- Payer
- payer Medicaid
Record id
0555f11c-c453-57eb-0336-faf71d6a3a2e