Claim CLM-2026206003
$32.49
billed
$22.74
allowed
$0.00
paid
$22.74
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Alendronic acid 10 MG Oral Tablet | 904419 | $0.00 | $0.00 |
| Therapeutic injection/administration | 96372 | $30.36 | $21.25 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Alendronic acid 10 MG Oral Tablet | 904419 | $0.00 | $0.00 |
| Therapeutic injection/administration | 96372 | $30.36 | $21.25 |