Average dental Claim with Information (Missing Teeth and Student) (id = "100151")

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">  <id value="100151"/>   <text>     <status value="generated"/>     <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Oral Health Claim</div>   </text>   <identifier>     <system value="http://happyvalley.com/claim"/>     <value value="12346"/>   </identifier>   <status value="active"/>   <type>     <coding>       <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>       <code value="oral"/>     </coding>   </type>   <use value="claim"/>   <patient>     <reference value="Patient/1"/>   </patient>   <created value="2014-08-16"/>   <insurer>     <reference value="Organization/2"/>   </insurer>   <provider>     <reference value="Organization/1"/>   </provider>   <priority>     <coding>       <code value="normal"/>     </coding>   </priority>   <payee>     <type>       <coding>         <code value="provider"/>       </coding>     </type>   </payee>   <careTeam>     <sequence value="1"/>     <provider>       <reference value="Practitioner/example"/>     </provider>   </careTeam>   <supportingInfo>     <sequence value="1"/>     <category>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>         <code value="missingtooth"/>       </coding>     </category>     <code>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/ex-tooth"/>         <code value="15"/>       </coding>     </code>     <timingDate value="2012-04-07"/>     <reason>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/missingtoothreason"/>         <code value="e"/>     <!--   Extraction   -->      </coding>     </reason>   </supportingInfo>   <supportingInfo>     <sequence value="2"/>     <category>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>         <code value="exception"/>       </coding>     </category>     <code>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/claim-exception"/>         <code value="student"/>       </coding>     </code>     <valueString value="Happy Valley Community College"/>   </supportingInfo>   <diagnosis>     <sequence value="1"/>     <diagnosisCodeableConcept>       <coding>         <code value="123456"/>       </coding>     </diagnosisCodeableConcept>   </diagnosis>   <insurance>     <sequence value="1"/>     <focal value="true"/>     <coverage>       <reference value="Coverage/9876B1"/>     </coverage>   </insurance>   <item>     <sequence value="1"/>     <careTeamSequence value="1"/>     <productOrService>       <coding>         <system value="http://example.org/fhir/oralservicecodes"/>         <code value="1200"/>       </coding>     </productOrService>     <servicedDate value="2014-08-16"/>     <unitPrice>       <value value="135.57"/>       <currency value="USD"/>      </unitPrice>      <net>       <value value="135.57"/>       <currency value="USD"/>      </net>    </item>   <item>     <sequence value="2"/>     <careTeamSequence value="1"/>     <productOrService>       <coding>         <system value="http://example.org/fhir/oralservicecodes"/>         <code value="21211"/>       </coding>     </productOrService>     <servicedDate value="2014-08-16"/>     <unitPrice>       <value value="105.00"/>       <currency value="USD"/>      </unitPrice>      <net>       <value value="105.00"/>       <currency value="USD"/>      </net>      <bodySite>       <site>          <concept>           <coding>             <system value="http://fdi.org/fhir/oraltoothcodes"/>             <code value="21"/>           </coding>         </concept>       </site>       <subSite>         <coding>           <system value="http://fdi.org/fhir/oralsurfacecodes"/>           <code value="L"/>         </coding>       </subSite>     </bodySite>   </item>   <item>     <sequence value="3"/>     <careTeamSequence value="1"/>     <productOrService>       <coding>         <system value="http://example.org/fhir/oralservicecodes"/>         <code value="27211"/>       </coding>     </productOrService>     <servicedDate value="2014-08-16"/>     <unitPrice>       <value value="1100.00"/>       <currency value="USD"/>      </unitPrice>      <net>       <value value="1100.00"/>       <currency value="USD"/>      </net>      <bodySite>       <site>         <concept>           <coding>             <system value="http://fdi.org/fhir/oraltoothcodes"/>             <code value="36"/>           </coding>         </concept>       </site>       </bodySite>     <detail>       <sequence value="1"/>       <productOrService>         <coding>           <system value="http://example.org/fhir/oralservicecodes"/>           <code value="27211"/>         </coding>       </productOrService>       <unitPrice>         <value value="1000.00"/>         <currency value="USD"/>        </unitPrice>        <factor value="0.75"/>     <!--   Student discount   -->      <net>         <value value="750.00"/>         <currency value="USD"/>        </net>      </detail>     <detail>       <sequence value="2"/>       <productOrService>         <coding>           <system value="http://example.org/fhir/oralservicecodes"/>           <code value="lab"/>         </coding>       </productOrService>       <unitPrice>         <value value="350.00"/>         <currency value="USD"/>        </unitPrice>        <net>         <value value="350.00"/>         <currency value="USD"/>        </net>      </detail>   </item> 


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Claim

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