<?xml version=“1.0” encoding=“UTF-8”?><Claim xmlns=“hl7.org/fhir”>

 <id value="100150"/>

 <text>
   <status value="generated"/>
   <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Oral Health Claim</div>
 </text>

 <type value="oral"/>

 <identifier>
   <system value="http://happyvalley.com/claim"/>
   <value value="12345"/>
 </identifier>

 <created value="2014-08-16"/>

 <target>
   <reference value="Organization/2"/>
 </target>

 <organization>
   <reference value="Organization/1"/>
 </organization>

 <use value="complete"/>

 <priority>
   <code value="normal"/>
 </priority>

 <payee>
   <type>
     <code value="provider"/>
   </type>
 </payee>

 <diagnosis>
   <sequence value="1"/>
   <diagnosis>
     <code value="123456"/>
   </diagnosis>
 </diagnosis>

 <patient>
   <reference value="Patient/1"/>
 </patient>

 <coverage>
   <sequence value="1"/>
   <focal value="true"/>
   <coverage>
     <reference value="Coverage/9876B1"/>
   </coverage>
   <relationship>
     <code value="self"/>
   </relationship>
 </coverage>

<item>
  <sequence value="1"/>
  <type>
    <code value="CSINV"/>
  </type>
  <provider>
    <reference value="Practitioner/example"/>
  </provider>
  <service>
    <code value="1200"/>
  </service>
  <serviceDate value="2014-08-16"/>
  <unitPrice>
     <value value="135.57"/>
     <system value="urn:iso:std:iso:4217"/>
     <code value="USD"/> 
  </unitPrice> 
  <net>
     <value value="135.57"/>
     <system value="urn:iso:std:iso:4217"/>
     <code value="USD"/> 
  </net> 
 </item>

</Claim>