Claim CLM-2026173000
$41.08
billed
$28.76
allowed
$0.00
paid
$28.76
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Simvastatin 10 MG Oral Tablet | 314231 | $0.00 | $0.00 |
| Therapeutic injection/administration | 96372 | $40.63 | $28.44 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Simvastatin 10 MG Oral Tablet | 314231 | $0.00 | $0.00 |
| Therapeutic injection/administration | 96372 | $40.63 | $28.44 |