Claim total
$232.78
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2017-04-02
- Stop
- 2017-04-02
The parties
- Provider
- provider Miyoko Botsford
- Care site
- care site FAIRVIEW HEALTH SERVICES
Record id
05f1dbc7-3ebc-37ee-85c4-cf0222d1dd95