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Takoda Joseph Tsosie MRN-101915 · born 1971-02-18 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-2026245003

Takoda Joseph Tsosie MRN-101915 Payer Medicare Service Feb 6, 2026 Status paid
$129.94
billed
$90.96
allowed
$0.00
paid
$90.96
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
tropicamide 5 MG/ML Ophthalmic Solution313521 $0.00 $0.00