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Elite Family Dental Care
789 Wellness Heights, Suite 102 Dallas, TX 75201 United States (214) 555-8822 [email protected] NPI: 9876543210
Receipt #: DEN-2026-5912
3/22/2026 9:45:00 AM
1
Comprehensive Dental Exam
$90.00
1
Digital Bitewing X-Rays (4)
$75.00
1
Periodontal Scaling & Root Planing
$185.00
1
Composite Resin Filling - Tooth #14 MO
$225.00
Subtotal
$575.00
Insurance Contract Discount
$-125.00
Total
$450.00
THANK YOU FOR CHOOSING ELITE FAMILY DENTAL CARE! Post-treatment care: Avoid cold beverages for 24 hours. Please contact us if you experience any sensitivity. NEXT APPOINTMENT: Sept 22, 2026 @ 10:00 AM www.elitedentalcare.com