Claim total
$225.23
base $93.39 · payer covered $175.23
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2026-01-04
- Stop
- 2026-01-04
The parties
- Patient
- patient Eleonora Elfriede Johns
- Provider
- provider Earle Keeling
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
059d8239-ee62-6881-847a-bd6514d0b7d2