Claims
Billed
$320.00
Allowed
$280.00
Approved
$280.00
Member Resp.
$40.00
Claim Details
- Provider
- Wellness Pediatrics
- Service Date
- Mar 22, 2026
- Submitted
- Mar 23, 2026
- Auto-Adjudicated
- Yes
Member
Diagnosis Codes
Z00.129— Encounter for routine child health examination(Principal)
Service Lines
| # | CPT | Description | Billed | Allowed | Approved | Member Resp. |
|---|---|---|---|---|---|---|
| 1 | 99385 | Preventive visit, new patient (18-39) | $320.00 | $195.00 | $195.00 | $40.00 |
Adjudication Trace
Fee schedule lookup
Eligibility check
Notes (0)
No notes yet.
Attachments (0)
No attachments yet.
PDF, TIFF, PNG, or JPG