MAR-22-28@2 99:58 FROM:DR.MAGNANI Thomas J, Magnani D.D, S$; Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 Att Mr. Jeff Epstein 301 East 66th Street Apt 10F New York NY 10066 —— § [ Gharges _ _—_ oS Ay E HISTORICAL STATEMENT yy 3 1/1/2013 to 3/21/2013 | i im — fe Date Dats Patient | |__Credits [Balance 1/4/2013 Recall (ral Exam 40.00 40.00 1/4/2013 Adult Stale & Prophy 180.00 220.00 1/4/2013 Add Perjapical X Rays 10.00 230.00 1/9/2013 Amalgain 2 Surface Perm. 375.00 605.00 1/29/2013 Porcelain W. Gold Crown 900.00 1,505.00 1/30/2013 0.00 1,505.00 [ Account Total 1,505.00 : Patient Charges 1,506.00 i Patient Payments 0.00 ! ' Patient Credits 0.00 i Patient Debits 0.00 Current 30 Days | 80 Days [iF | 90 Days 120+ Days | ‘i i is Thomas J,MagnaniD.D.$ AWinG BR. 7 West stst su H} 7iFloor New York NY 10019 FY EFTA00283635