Claim total
$148.57
base $93.39 · payer covered $98.57
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2014-09-30
- Stop
- 2014-09-30
The parties
- Patient
- patient Mirta Nakisha Franecki
- Provider
- provider Amber Yost
- Payer
- payer Medicaid
Record id
05902870-85f1-fda1-0573-7355ea5ddf2c