Claim CLM-2026078005
$142.58
billed
$99.81
allowed
$99.81
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Prenatal visit (regime/therapy) | 424619006 | $0.00 | $0.00 |
| Miscarriage in second trimester (disorder) | 85116003 | $0.00 | $0.00 |
| Congenital uterine anomaly (disorder) | 37849005 | $0.00 | $0.00 |