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November 7, 2025

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

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Invoice Number:140979
Billing Period:01/01/2007 - 01/31/2007

Dental Group Number:03905-000-00005-00000
Vision Group Number:40013-000-00000-00000
Group Name:FULLY INSURED JOINT-BILLED
Master Number:10302
Description: 
Phone Number:(999) 999-0000

FULLY INSURED JOINT-BILLED
JANE SINCLAIR
500 DIAMOND AVENUE
ANYWHERE, USA 55555-0000

PRIOR DUE
 Prior Amount Due$3,389.57 
 Less Payment Received 3,389.57 
 Balance From Prior Billing .00 
     
 
CURRENT DUE
 Dental Total Subscriber Adjustments$42.84 
 Vision Total Subscriber Adjustments 3.01 
 Total Total Subscriber Adjustments$45.85 
     
 Dental Current Billed 3,076.42 
 Vision Current Billed 257.53 
 Total Current Billed$3,333.95 
     
 
 Total Amount Due$3,333.95