Claim total
$315.82
base $93.39 · payer covered $265.82
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2022-04-17
- Stop
- 2022-04-17
The parties
- Patient
- patient Rex Jules Denesik
- Provider
- provider Clyde Beier
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
06303127-1d9c-5fa8-003f-908806434480