<Claim xmlns="http://hl7.org/fhir"><id value="100156"/><text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Oral Health Claim</div></text><contained><Device><id value="device-bridge"/></Device></contained><contained><ServiceRequest><id value="referral"/><status value="active"/><intent value="order"/><subject><reference value="Patient/1"/></subject></ServiceRequest></contained><identifier><system value="http://happyvalley.com/claim"/><value value="123466"/></identifier><status value="active"/><type><coding><system value="http://terminology.hl7.org/CodeSystem/claim-type"/><code value="oral"/></coding></type><use value="claim"/><subject><reference value="Patient/1"/></subject><created value="2014-08-16"/><insurer><reference value="Organization/2"/></insurer><provider><reference value="Organization/1"/></provider><priority><coding><code value="normal"/></coding></priority><related><claim><reference 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value="2014-07-04"/><procedureCodeableConcept><text value="Resection of gum to increase exposed tooth."/></procedureCodeableConcept></procedure><insurance><sequence value="1"/><focal value="true"/><coverage><reference value="Coverage/9876B1"/></coverage></insurance><item><sequence value="1"/><careTeamSequence value="1"/><informationSequence value="1"/><productOrService><coding><system value="http://example.org/fhir/oralservicecodes"/><code value="67221"/><display value="Maryland Bridge"/></coding></productOrService><servicedDate value="2014-08-16"/><locationCodeableConcept><coding><system value="http://terminology.hl7.org/CodeSystem/ex-serviceplace"/><code value="11"/></coding></locationCodeableConcept><unitPrice><value value="1400.00"/><currency value="USD"/></unitPrice><factor value="0.75"/><net><value value="1050.00"/><currency value="USD"/></net><udi><reference value="#device-bridge"/></udi><bodySite><site><concept><coding><system value="http://fdi.org/fhir/oraltoothcodes"/><code 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value="350.00"/><currency value="USD"/></unitPrice><net><value value="350.00"/><currency value="USD"/></net></detail></item><total><value value="2255.00"/><currency value="USD"/></total></Claim>