If Mr Corvervettes EOB says amount billed is $75.00, Allowed amount is $50.00, deduction is $0.00, coinsurance is $10.00, group recieved amount is $25.00, and provider paid $40.00. What would block #2

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If Mr Corvervettes EOB says amount billed is $75.00, Allowed amount is $50.00, deduction is $0.00, coinsurance is $10.00, group recieved amount is $25.00, and provider paid $40.00. What would block #29 and #30 be on the CMS 1500.

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