{"coverage":[{"coverage":{"reference":"Coverage/9876B1"},"focal":true,"relationship":{"code":"self"},"sequence":1}],"created":"2015-03-16","diagnosis":[{"diagnosis":{"code":"123457","system":"http://hl7.org/fhir/sid/icd-10"},"sequence":1}],"id":"100153","identifier":[{"system":"http://happyvalley.com/claim","value":"12355"}],"item":[{"detail":[{"net":{"code":"USD","system":"urn:iso:std:iso:4217","value":1000.00},"sequence":1,"service":{"code":"ORTHOEXAM","system":"http://hl7.org/fhir/oralservicecodes"},"type":{"code":"CSINV","system":"http://hl7.org/fhir/v3/ActCode"},"unitPrice":{"code":"USD","system":"urn:iso:std:iso:4217","value":1000.00}},{"net":{"code":"USD","system":"urn:iso:std:iso:4217","value":1500.00},"sequence":2,"service":{"code":"ORTHODIAG","system":"http://hl7.org/fhir/oralservicecodes"},"type":{"code":"CSINV","system":"http://hl7.org/fhir/v3/ActCode"},"unitPrice":{"code":"USD","system":"urn:iso:std:iso:4217","value":1500.00}},{"net":{"code":"USD","system":"urn:iso:std:iso:4217","value":500.00},"sequence":3,"service":{"code":"ORTHOINITIAL","system":"http://hl7.org/fhir/oralservicecodes"},"type":{"code":"CSINV","system":"http://hl7.org/fhir/v3/ActCode"},"unitPrice":{"code":"USD","system":"urn:iso:std:iso:4217","value":500.00}},{"quantity":{"value":24},"sequence":4,"service":{"code":"ORTHOMONTHS","system":"http://hl7.org/fhir/oralservicecodes"},"type":{"code":"CSINV","system":"http://hl7.org/fhir/v3/ActCode"}},{"net":{"code":"USD","system":"urn:iso:std:iso:4217","value":250.00},"quantity":{"value":24},"sequence":5,"service":{"code":"ORTHOPERIODIC","system":"http://hl7.org/fhir/oralservicecodes"},"type":{"code":"CSINV","system":"http://hl7.org/fhir/v3/ActCode"},"unitPrice":{"code":"USD","system":"urn:iso:std:iso:4217","value":250.00}}],"diagnosisLinkId":[1],"net":{"code":"USD","system":"urn:iso:std:iso:4217","value":9000.00},"provider":{"reference":"Practitioner/example"},"sequence":1,"service":{"code":"ORTHPLAN","system":"http://hl7.org/fhir/oralservicecodes"},"serviceDate":"2015-05-16","type":{"code":"FRAMEING","system":"http://hl7.org/fhir/v3/ActCode"},"unitPrice":{"code":"USD","system":"urn:iso:std:iso:4217","value":9000.00}},{"bodySite":{"code":"21","system":"http://fdi.org/fhir/oraltoothcodes"},"net":{"code":"USD","system":"urn:iso:std:iso:4217","value":105.00},"provider":{"reference":"Practitioner/example"},"sequence":2,"service":{"code":"21211","system":"http://hl7.org/fhir/oralservicecodes"},"serviceDate":"2014-08-16","subSite":[{"code":"L","system":"http://fdi.org/fhir/oralsurfacecodes"}],"type":{"code":"service"},"unitPrice":{"code":"USD","system":"urn:iso:std:iso:4217","value":105.00}},{"bodySite":{"code":"36","system":"http://fdi.org/fhir/oraltoothcodes"},"detail":[{"net":{"code":"USD","system":"urn:iso:std:iso:4217","value":750.00},"sequence":1,"service":{"code":"27211","system":"http://hl7.org/fhir/oralservicecodes"},"type":{"code":"service"},"unitPrice":{"code":"USD","system":"urn:iso:std:iso:4217","value":750.00}},{"net":{"code":"USD","system":"urn:iso:std:iso:4217","value":350.00},"sequence":2,"service":{"code":"lab","system":"http://hl7.org/fhir/oralservicecodes"},"type":{"code":"service"},"unitPrice":{"code":"USD","system":"urn:iso:std:iso:4217","value":350.00}}],"net":{"code":"USD","system":"urn:iso:std:iso:4217","value":1100.00},"provider":{"reference":"Practitioner/example"},"sequence":3,"service":{"code":"27211","system":"http://hl7.org/fhir/oralservicecodes"},"serviceDate":"2014-08-16","type":{"code":"group"},"unitPrice":{"code":"USD","system":"urn:iso:std:iso:4217","value":1100.00}}],"organization":{"reference":"Organization/1"},"patient":{"reference":"Patient/1"},"payee":{"type":{"code":"provider"}},"priority":{"code":"normal"},"resourceType":"Claim","target":{"reference":"Organization/2"},"text":{"div":"<div>A human-readable rendering of the Oral Health Claim</div>","status":"generated"},"type":"oral","use":"proposed"}