Vous êtes sur la page 1sur 2

Dental Services rendered to dependents of Pepsi-Cola Employees:

March 4, 2017 Prian Quizol


Oral Prophylaxis 85.00
Med given
Gingival set 150.00
Charged to Mrs. Rowena Quizol
March 13, 2017 Liza Tan
Oral Prophylaxis 85.00
Charged to Mr. Jerome Tan
June 14, 2017 Raquel Paraiso
Oral Prophylaxis 85.00
June 15, 2017 Raquel Paraiso
Tooth Extraction upper right 1st molar 300.00
Tooth Extraction upper right 2nd molar 200.00

Medicines given:
5 tabs Dostan 200.00
10 caps Ponstan 500.00
700.00
Charged to Mr. Rigen Paraiso
Sept. 15, 2017 Rhianne Cajibe
Oral Prophylaxis 85.00
Tooth Extraction (Lower right 1st 300.00
molar)
Charged to Mrs. Liezyl Cajibe
Sept. 7, 2017 Mari Cris Dagle
Oral Prophylaxis 85.00
Charged to Nilo Dagle
August 6, 2017 Avi Casilan
Oral Prophylaxis 85.00
Tooth Extraction:
Upper le3ft central incisor 200.00
Upper right central incisor 200.00

Medicines given:
7 tabs Ponseen x 20 140.00
4 tabs Dostan x40 160.00
Charged to Mrs. Didith Casilan
TOTAL: 2,860.00

Prepared and Submitted by:

DR. SOCORRO C. TRISTE


Dentist
Dental Services to the Pepsi Cola Employees:

May 27, 2017 Jimbo F. Rabi


Oral Prophylaxis 85.00
March 4, 2017 Rowena Quizol
Oral Prophylaxis 85.00
Sept. 18, 2017 Roger Parenosaan
Oral Prophylaxis 85.00

Tooth Extraction
Lower right 3rd Molar
Utilizing 3 dental anesthesia 300.00

Tooth Extraction
Lower right 2nd molar
Utilizing 2 dental anesthesia 200.00
TOTAL: 755.00

Prepared and Submitted by:

DR. SOCORRO C. TRISTE


Dentist