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

<id value="R3500"/>

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

 <identifier>
   <system value="http://www.BenefitsInc.com/fhir/eob"/>
   <value value="987654321"/>
 </identifier>

 <request>
       <reference value="http://www.BenefitsInc.com/fhir/oralhealthclaim/15476332402"/>
 </request>

 <outcome value="complete"/>

 <disposition value="Claim settled as per contract."/>

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

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

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

</ExplanationOfBenefit>