Case File
efta-efta00316502DOJ Data Set 9OtherSINGLE PATIENT LEDGER
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00316502
Pages
1
Persons
0
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SINGLE PATIENT LEDGER
Thomas J. Magnani, D.D.S.
04/18/2019
1
Patient Name:
9 East 71st Street
New York, NY 10021
Chart Number.
Billing Type: 1
DATE
TEETH
DESCRIPTION
PATIENT
CHARGE
PAYMENT
BALANCE
02/18/2019
Patient Balance Forward
0.00
0.00
02/19/2019
Prophylaxis-adult
180.00
180.00
02/19/2019
Periodic oral evaluation
40.00
220.00
02/21/2019
Whitening Gel 22%
65.00
285.00
02/21/2019
3
Amalgam-2 surf.
450.00
735.00
02/21/2019
4
Resin composite-1s, posterior
425.00
1160.00
TOTAL PATIENT BALANCE AS OF 0411812019:
1160.00
EFTA00316502
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