{

"resourceType": "Claim",
"id": "100152",
"text": {
  "status": "generated",
  "div": "<div>A human-readable rendering of the Oral Health Claim</div>"
},
"contained": [
  {
    "resourceType": "Organization",
    "id": "organization-1",
    "identifier": [
      {
        "system": "http://www.jurisdiction.com/oralhealthoffices",
        "value": "3456"
      }
    ]
  },
  {
    "resourceType": "Organization",
    "id": "organization-2",
    "identifier": [
      {
        "system": "http://www.bindb.com/bin",
        "value": "123456"
      }
    ]
  },
  {
    "resourceType": "Practitioner",
    "id": "practitioner-1",
    "identifier": [
      {
        "system": "http://www.jurisdiction.com/oralhealthproviders",
        "value": "123456789"
      }
    ]
  },
  {
    "resourceType": "Patient",
    "id": "patient-1",
    "name": [
      {
        "use": "official",
        "family": [
          "Donald"
        ],
        "given": [
          "Duck"
        ]
      }
    ],
    "gender": "male",
    "birthDate": "1986-05-17",
    "address": [
      {
        "use": "home",
        "line": [
          "1234 Main Street"
        ],
        "city": "Vancouver",
        "postalCode": "V2H1Y3",
        "country": "CAD"
      }
    ]
  },
  {
    "resourceType": "Coverage",
    "id": "coverage-1",
    "issuer": {
      "reference": "#organization-2"
    },
    "type": {
      "system": "http://hl7.org/fhir/v3/ActCode",
      "code": "EHCPOL"
    },
    "identifier": [
      {
        "system": "http://benefitsinc.com/certificate",
        "value": "12345"
      }
    ],
    "plan": "CBI35",
    "subPlan": "123",
    "dependent": 1,
    "sequence": 1,
    "subscriber": {
      "reference": "#patient-1"
    }
  }
],
"type": "oral",
"identifier": [
  {
    "system": "http://happyvalley.com/claim",
    "value": "12347"
  }
],
"created": "2014-08-16",
"target": {
  "reference": "#organization-2"
},
"organization": {
  "reference": "#organization-1"
},
"use": "complete",
"priority": {
  "code": "normal"
},
"payee": {
  "type": {
    "code": "provider"
  }
},
"diagnosis": [
  {
    "sequence": 1,
    "diagnosis": {
      "code": "123456"
    }
  }
],
"patient": {
  "reference": "#patient-1"
},
"coverage": [
  {
    "sequence": 1,
    "focal": true,
    "coverage": {
      "reference": "#coverage-1"
    },
    "relationship": {
      "code": "self"
    }
  }
],
"item": [
  {
    "sequence": 1,
    "type": {
      "code": "CSINV"
    },
    "provider": {
      "reference": "#practitioner-1"
    },
    "service": {
      "code": "1200"
    },
    "serviceDate": "2014-08-16",
    "unitPrice": {
      "value": 135.57,
      "system": "urn:iso:std:iso:4217",
      "code": "USD"
    },
    "net": {
      "value": 135.57,
      "system": "urn:iso:std:iso:4217",
      "code": "USD"
    }
  }
]

}