| # | Medical Service / Procedure | Description | Unit Cost | Qty | Total |
|---|---|---|---|---|---|
| 1 | General Dental Consultation | Comprehensive oral exam & digital X-Rays | $100.00 | 1 | $100.00 |
| 2 | Teeth Cleaning & Scaling | Deep ultrasonic prophylaxis scaling | $150.00 | 1 | $150.00 |
| 3 | Fluoride Protective Treatment | Topical enamel remineralization varnish | $80.00 | 1 | $80.00 |
| 4 | Prescription Care Kit | Post-procedure antiseptic oral rinse & gel | $25.00 | 2 | $50.00 |
| Subtotal: | $380.00 |
| Tax (VAT 10%): | $38.00 |
| Discount: | -$18.00 |
| Grand Total: | $400.00 |
Payment has been successfully processed and verified. Please retain this invoice for your medical insurance and health savings account reimbursements.
