SINGLE PATIENT LEDGER Thomas J. Magnani, D.D.S. Date: 08/31/2017 Page: 1 Patient Name: Chart Number:AR0002 Billing Type: 1 DATE TEETH DESCRIPTION PATENT 06/30/2017 07/10/2017 07/12/2017 07/12/2017 07/12/2017 07/12/2017 07/12/2017 07/12/2017 22 07/12/2017 22 07/12/2017 27 07/14/2017 07/20/2017 07/27/2017 I CHARGE PAYMENT BALANCE 0.00 0.00 600.00 600.00 750.00 1350.00 750.00 2100.00 650.00 2750.00 650.00 3400.00 0.00 3400.00 525.00 3925.00 2500.00 6425.00 525.00 6950.00 0.00 6950.00 0.00 6950.00 0.00 6950.00 TOTAL PATIENT BALANCE AS OF 08/31/2017: 6950.00 EFTA00316352