Claim CLM-2026206001
$87.21
billed
$1.53
allowed
$1.33
paid
$0.20
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Encounter for check up (procedure) | 185349003 | $0.00 | $0.00 |
| intravenous moderate (conscious) sedation/analgesia - each subsequent 15 minute increment | D9243 | $1.66 | $1.16 |