03/15/2018 Page: 1 Date: Patient Name Chart Number: Billing Type: 4 DATE _ TEETH DESCRIPTION PATIENT _ CHARGE PAYMENT BALANCE 02/07/2018 0.00 0.00 02/08/2018 0.00 0.00 02/08/2018 31 35.00 35.00 02/21/2018 0.00 35.00 03/08/2018 0.00 35.00 03/08/2018 31 425.00 460.00 03/08/2018 31 2400.00 2860.00 03/08/2018 0,00 2860.00 |_ TOTAL PATIENT BALANCE AS OF 03/15/2018: 2860.00 EFTA00292244