Invoice #1024
Oct 12, 2026, 2:00 PM
Summary
Refunded
| Item | Qty | Price | Amount |
|---|---|---|---|
| Composite filling | 1 | $310.00 | $310.00 |
| New patient exam, x-rays and cleaning | 1 | $115.00 | $115.00 |
Total$425.00
Refunded$425.00
Patient
Name
Email
hannah.pierce@example.net
Phone
(630) 555-0147
Payment
Status
Refunded
Due
Oct 26, 2026