Current Location: Home > Interactive Demonstration > Employer Connection > Billing Invoices > Sales Dental Billing Invoice Summary
May 19, 2026

My Invoices Invoice Summary Dental Subscriber Adjustments Dental Active Subscribers Statement of Account

Download
Customize & Download Statement (PDF)
Download Statement (Excel)
Download Eligibility Worksheet (PDF)
Invoice Number:138355
Billing Period:01/01/2007 - 01/31/2007

Dental Group Number:20883-000-00000-28011
Group Name:FULLY INSURED 
Master Number:00000
Description: 
Phone Number:(999) 999-0000

FULLY INSURED 
100 MAIN STREET
ANYWHERE, USA 55555-0000

PRIOR DUE
 Prior Amount Due$2,035.92 
 Less Payment Received 2,035.92 
 Balance From Prior Billing .00 
 
CURRENT DUE
 Total Subscriber Adjustments$163.36 
 Current Billed 2,339.88 
 Balance From Current Billing 2,339.88 
 
 Total Amount Due$2,503.24