Invoice Number Patient Last Name Patient First Name

1 Aurea Irish
2 Legaspi Precious Mae
3 Aurea Jordan
4 Ramirez Kritine Jewel
5 Legaspi Keneth
6 Olfato JohnClarence
7 Cosio Samuel
8 Mascardo David James
9 Espino Rosecelle
10 Duyaguit Jemaima
Patient Middle Initial Street Address City
T. San Isidro Labrador 1 Dasmariñ as
A. Cardinal Dasmariñ as
T. Summerwind Trece Martires
B. San Isidro Labrador 2 Dasmariñ as
A. South Garden Dasmariñ as
G. Maguyam Silang
K. Toclong Kawit, Cavite
G. Summerwind Trece Martires
W. Rich Lane Imus
L. San Dionisio Las Piñ as
 Phone Dentist
9328466887 Dr. I. Lagarto
9257329891 Dr. I. Lagarto
9498484530 Dr. I. Lagarto
9193945217 Dr. I. Lagarto
9231757823 Dr. I. Lagarto
9163694281 Dr. I. Lagarto
9834532454 Dr. I. Lagarto
9974837894 Dr. I. Lagarto
9460158009 Dr. I. Lagarto
9063874714 Dr. I. Lagarto
 Project or Service Description
Ceramic or Tooth-Colored Braces
Scaling/Root Planning and Cleaning
Composite Resin Fillings
Diastema/Space Closing
Porcelain Jacket Crown (Fused to Gold) (Captex)
Laser Tooth Whitening
Oral Prophylaxis (Moderate)
Tooth Extraction
Removal of Tooth Impaction (Third Molar)
Gingivictomy
 Service 1 Amount 1
Upper & Lower Braces 10,000.00
Root Canal Treatment (Anterior) 3,500.00
Crown removal of teeth #34, #15 & #44 3,000.00
Anterior teeth of upper arch 600
Construction & placing of jacket for #11 18,000.00
Tooth Whitening (1 hour treatment) 25,000.00
Cleaning of upper & lower arch 600
Tooth #14 500
Wisdom tooth (#36) removal 6,000.00
Upper & lower arch 2,000.00

Total: 69200
 Service2 Amount 2
Follow-up check ups (25 months) 35,000.00
Root Canal Treatment (Posterior) 4,000.00
Fillings placed on teeth #34, #15 & #44 1,800.00

40800
 Total
45,000.00
7,500.00
4,800.00
600
18,000.00
25,000.00
600
500
6,000.00
2,000.00

110,000.00