Simple dental Claim

{
  "resourceType": "Claim",
  "id": "100150",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>"

  "resourceType" : "Claim",
  "id" : "100150",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>"

  },
  "identifier": [
    {
      "system": "http://happyvalley.com/claim",
      "value": "12345"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "oral"
      }
    ]

  "identifier" : [{
    "system" : "http://happyvalley.com/claim",
    "value" : "12345"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "oral"
    }]

  },
  "use": "claim",
  "patient": {
    "reference": "Patient/1"

  "use" : "claim",
  "subject" : {
    "reference" : "Patient/1"

  },
  "created": "2014-08-16",
  "insurer": {
    "reference": "Organization/2"

  "created" : "2014-08-16",
  "insurer" : {
    "reference" : "Organization/2"

  },
  "provider": {
    "reference": "Organization/1"

  "provider" : {
    "reference" : "Organization/1"

  },
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]

  "priority" : {
    "coding" : [{
      "code" : "normal"
    }]

  },
  "payee": {
    "type": {
      "coding": [
        {
          "code": "provider"
        }
      ]

  "payee" : {
    "type" : {
      "coding" : [{
        "code" : "provider"
      }]

    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example"
      }

  "careTeam" : [{
    "sequence" : 1,
    "provider" : {
      "reference" : "Practitioner/example"

    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "123456"
          }
        ]
      }

  }],
  "diagnosis" : [{
    "sequence" : 1,
    "diagnosisCodeableConcept" : {
      "coding" : [{
        "code" : "123456"
      }]

    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "identifier": {
        "system": "http://happyvalley.com/claim",
        "value": "12345"
      },
      "coverage": {
        "reference": "Coverage/9876B1"
      }

  }],
  "insurance" : [{
    "sequence" : 1,
    "focal" : true,
    "identifier" : {
      "system" : "http://happyvalley.com/claim",
      "value" : "12345"
    },
    "coverage" : {
      "reference" : "Coverage/9876B1"

    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "code": "1200"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 135.57,
        "currency": "USD"
      },
      "net": {
        "value": 135.57,
        "currency": "USD"
      }

  }],
  "item" : [{
    "sequence" : 1,
    "careTeamSequence" : [1],
    "productOrService" : {
      "coding" : [{
        "code" : "1200"
      }]
    },
    "servicedDate" : "2014-08-16",
    "unitPrice" : {
      "value" : 135.57,
      "currency" : "USD"
    },
    "net" : {
      "value" : 135.57,
      "currency" : "USD"

    }
  ]

  }]

}