<ExplanationOfBenefit xmlns="http://hl7.org/fhir">
  <id value="core-examples-ExplanationOfBenefit-example" />
  <meta>
    <versionId value="1" />
    <lastUpdated value="2016-09-08T11:37:51.484+00:00" />
  </meta>
  <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>