SOA Dental Claim (Contained)

{
  "resourceType" : "Claim",
  "id" : "100152",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>"
  },
  "contained" : [{
    "resourceType" : "Organization",
    "id" : "org-insurer",
    "identifier" : [{
      "system" : "http://www.bindb.com/bin",
      "value" : "123456"
    }]
  },
  {
    "resourceType" : "Organization",
    "id" : "org-org",
    "identifier" : [{
      "system" : "http://www.jurisdiction.com/oralhealthoffices",
      "value" : "3456"
    }]
  },
  {
    "resourceType" : "Practitioner",
    "id" : "provider-1",
    "identifier" : [{
      "system" : "http://www.jurisdiction.com/oralhealthproviders",
      "value" : "123456789"
    }]
  },
  {
    "resourceType" : "Patient",
    "id" : "patient-1",
    "name" : [{
      "use" : "official",
      "family" : "Donald",
      "given" : ["Duck"]
    }],
    "gender" : "male",
    "birthDate" : "1986-05-17",
    "address" : [{
      "use" : "home",
      "line" : ["1234 Main Street"],
      "city" : "Vancouver",
      "postalCode" : "V2H1Y3",
      "country" : "CAD"
    }]
  },
  {
    "resourceType" : "Coverage",
    "id" : "coverage-1",
    "identifier" : [{
      "system" : "http://benefitsinc.com/certificate",
      "value" : "12345"
    }],
    "status" : "active",
    "kind" : "insurance",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "EHCPOL"
      }]
    },
    "subscriber" : {
      "reference" : "#patient-1"
    },
    "beneficiary" : {
      "reference" : "#patient-1"
    },
    "dependent" : "1",
    "relationship" : {
      "coding" : [{
        "code" : "self"
      }]
    },
    "insurer" : {
      "identifier" : {
        "system" : "http://www.bindb.com/bin",
        "value" : "123456"
      }
    },
    "class" : [{
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code" : "plan"
        }]
      },
      "value" : {
        "value" : "CBI35"
      },
      "name" : "Corporate Baker's Inc. Plan#35"
    },
    {
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code" : "subplan"
        }]
      },
      "value" : {
        "value" : "123"
      },
      "name" : "Trainee Part-time Benefits"
    },
    {
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code" : "sequence"
        }]
      },
      "value" : {
        "value" : "1"
      }
    }]
  }],
  "identifier" : [{
    "system" : "http://happyvalley.com/claim",
    "value" : "12347"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "oral"
    }]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "#patient-1"
  },
  "created" : "2014-08-16",
  "insurer" : {
    "reference" : "#org-insurer"
  },
  "provider" : {
    "reference" : "#org-org"
  },
  "priority" : {
    "coding" : [{
      "code" : "normal"
    }]
  },
  "payee" : {
    "type" : {
      "coding" : [{
        "code" : "provider"
      }]
    }
  },
  "careTeam" : [{
    "sequence" : 1,
    "provider" : {
      "reference" : "#provider-1"
    }
  }],
  "diagnosis" : [{
    "sequence" : 1,
    "diagnosisCodeableConcept" : {
      "coding" : [{
        "code" : "123456"
      }]
    }
  }],
  "insurance" : [{
    "sequence" : 1,
    "focal" : true,
    "coverage" : {
      "reference" : "#coverage-1"
    }
  }],
  "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"
    }
  }]
}