ate Procedure Description Paid by Charges Insurance Paid By Patient Adj. Balance 01/11/2019 01/11/2019 99212 17000 Established Pt Visit Straightfwrd Dest Ben/Premalig 1st 250 25'.00 250.00 250.00 01/11/2019 17003 Dest Ben/Premal 2-14 50.00 150.00 A Gate- 1,,ni- efruct, ivtt 4 -c c) 0 el