{
  "resourceType": "Claim",
  "id": "CLM-SAMPLE-001",
  "status": "active",
  "patient": {
    "reference": "Patient/PAT-SAMPLE-001"
  },
  "item": [
    {
      "productOrService": {
        "coding": [
          {
            "code": "99213",
            "display": "Office visit SAMPLE"
          }
        ]
      }
    }
  ]
}