GQE-112117-305036c275

21 Nov 2017
# Item Codes and Description Quantity Price
1 Demo Service  –  [For Tooth Number(s): (12,18,28,47)]
  • s-001:
  • d-0001:
4x(130.00)
  • 4x(15.00)
  • 4x(115.00)
520.00
2 Service 1  –  [For Tooth Number(s): (17,22,28,47)]
  • s-001:
4x(15.00)
  • 4x(15.00)
60.00
3 Demo Service  –  [For Tooth Number(s): (11,16)]
  • s-001:
  • d-0001:
2x(130.00)
  • 2x(15.00)
  • 2x(115.00)
260.00
4 Demo Procedure  –  [For Tooth Number(s): (12,28)]
  • d-0001:
2x(115.00)
  • 2x(115.00)
230.00
5 Procedure 1
  • s-001:
1x(15.00)
  • 1x(15.00)
15.00
6 s-001  –  [For Tooth Number(s): (18,47)]
  • s-001:
2x(15.00)
  • 2x(15.00)
30.00
7 d-0001  –  [For Tooth Number(s): (16,26)]
  • d-0001:
2x(115.00)
  • 2x(115.00)
230.00
Sub Total (A): 1,345.00
Discount Total (B): (percentage) : 5.00 67.25
Gross Total (C): (A – B) 1,277.75
Cover Payout (D): 1,249.97
Gap Total (Est.): (C – D) 27.78

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