{"careTeam":[{"provider":{"reference":"Practitioner/example"},"sequence":1}],"created":"2014-08-16","diagnosis":[{"diagnosisCodeableConcept":{"coding":[{"code":"123456"}]},"sequence":1}],"id":"100151","identifier":[{"system":"http://happyvalley.com/claim","value":"12346"}],"insurance":[{"coverage":{"reference":"Coverage/9876B1"},"focal":true,"sequence":1}],"insurer":{"reference":"Organization/2"},"item":[{"careTeamSequence":[1],"net":{"currency":"USD","value":135.57},"productOrService":{"coding":[{"code":"1200","system":"http://example.org/fhir/oralservicecodes"}]},"sequence":1,"servicedDate":"2014-08-16","unitPrice":{"currency":"USD","value":135.57}},{"bodySite":[{"site":[{"concept":{"coding":[{"code":"21","system":"http://fdi.org/fhir/oraltoothcodes"}]}}],"subSite":[{"coding":[{"code":"L","system":"http://fdi.org/fhir/oralsurfacecodes"}]}]}],"careTeamSequence":[1],"net":{"currency":"USD","value":105},"productOrService":{"coding":[{"code":"21211","system":"http://example.org/fhir/oralservicecodes"}]},"sequence":2,"servicedDate":"2014-08-16","unitPrice":{"currency":"USD","value":105}},{"bodySite":[{"site":[{"concept":{"coding":[{"code":"36","system":"http://fdi.org/fhir/oraltoothcodes"}]}}]}],"careTeamSequence":[1],"detail":[{"factor":0.75,"net":{"currency":"USD","value":750},"productOrService":{"coding":[{"code":"27211","system":"http://example.org/fhir/oralservicecodes"}]},"sequence":1,"unitPrice":{"currency":"USD","value":1000}},{"net":{"currency":"USD","value":350},"productOrService":{"coding":[{"code":"lab","system":"http://example.org/fhir/oralservicecodes"}]},"sequence":2,"unitPrice":{"currency":"USD","value":350}}],"net":{"currency":"USD","value":1100},"productOrService":{"coding":[{"code":"27211","system":"http://example.org/fhir/oralservicecodes"}]},"sequence":3,"servicedDate":"2014-08-16","unitPrice":{"currency":"USD","value":1100}}],"payee":{"type":{"coding":[{"code":"provider"}]}},"priority":{"coding":[{"code":"normal"}]},"provider":{"reference":"Organization/1"},"resourceType":"Claim","status":"active","subject":{"reference":"Patient/1"},"supportingInfo":[{"category":{"coding":[{"code":"missingtooth","system":"http://terminology.hl7.org/CodeSystem/claiminformationcategory"}]},"code":{"coding":[{"code":"15","system":"http://terminology.hl7.org/CodeSystem/ex-tooth"}]},"reason":{"coding":[{"code":"e","system":"http://terminology.hl7.org/CodeSystem/missingtoothreason"}]},"sequence":1,"timingDateTime":"2012-04-07"},{"category":{"coding":[{"code":"exception","system":"http://terminology.hl7.org/CodeSystem/claiminformationcategory"}]},"code":{"coding":[{"code":"student","system":"http://terminology.hl7.org/CodeSystem/claim-exception"}]},"sequence":2,"valueString":"Happy Valley Community College"}],"text":{"div":"<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>","status":"generated"},"type":{"coding":[{"code":"oral","system":"http://terminology.hl7.org/CodeSystem/claim-type"}]},"use":"claim"}