Claim total
$326.61
base $93.39 · payer covered $276.61
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2026-05-10
- Stop
- 2026-05-10
The parties
- Patient
- patient Rex Jules Denesik
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
06303127-1d9c-5fa8-c7ba-9c93f3ee565a