Claim total
$101.76
base $93.39 · payer covered $51.76
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2020-09-16
- Stop
- 2020-09-16
The parties
- Patient
- patient Adam Alfonzo Stokes
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
056ed411-c295-a5c9-2561-00c23a7ce5e4