REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT 77:late Patient Description Charges Credits Balance 3/28/2013 Previous Balance 0.00 4/2/2013 Svetleana Recall Oral Exam 40.00 40.00 4/2/2013 Svetleana Adult Scale & Prophy 180.00 220.00 4/2/2013 Svetleana Bleach Touch-Up Kit 65.00 285.00

New York NY 10010 Mr. Jeff Epstein 301 East 66th Street Apt 310F New York NY 10065 Cate Patient Deacripdon 11/6/2013 11/8/2013 11/6/2013 Svetleana Svetleana Svetleana Recall Oral Exam Adult Scale & Prophy Bite Wings 4 Films urfaoe Perm. Current 30 Days 80 Dee 11/6/2013 to 2112/2014 HI