Contact Us
| Current Location: | Home > Interactive Demonstration > Employer Connection > Billing Invoices > Dental ASO 2 Digit Invoice Summary A |
April 28, 2025
|
| Download |
|---|
 Customize & Download Statement (PDF) Download Eligibility Worksheet (PDF) |
| Invoice Number: | 148348 |
| Reconciliation Period: | 01/01/2007 - 01/31/2007 |
| Master Number: | 03000-00 |
| Description: | |
| Phone Number: | (999) 999-0000 |
| SELF INSURED SUMMARY |
| BENEFITS ADMINISTRATOR |
| 321 UNIVERSITY AVENUE |
| ANYWHERE, USA 55555-0000 |
| PRIOR DUE | ||||
|---|---|---|---|---|
| Prior Amount Due | $ | .00 | ||
| Less Deposits Received | 4,916.50 | |||
| Balance Forward | 4,916.50 | - | ||
| CURRENT DUE | ||||
| Total Administration Adjustments | $ | 8.30 | ||
| Current Administration Billed | 348.60 | |||
| Claim Payments | 4,559.60 | |||
| Balance From Current Billing | 4,916.50 | |||
| Total Amount Due | $ | .00 | ||