Claim CLM-2026185004
$35.93
billed
$25.15
allowed
$0.00
paid
$25.15
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Simvastatin 10 MG Oral Tablet | 314231 | $0.00 | $0.00 |
| Therapeutic injection/administration | 96372 | $35.63 | $24.94 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Simvastatin 10 MG Oral Tablet | 314231 | $0.00 | $0.00 |
| Therapeutic injection/administration | 96372 | $35.63 | $24.94 |