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On June 3, we will be upgrading our benefits administration system. As part of this upgrade, the employer portal will be updated, and new user registrations will not be available until June 3. Please visit our upgrade resources and FAQs to learn more. |
| Current Location: | Home > Interactive Demonstration > Employer Connection > Billing Invoices > Dental ASO 2 Digit Invoice Summary A |
May 19, 2026
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 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 | ||