Your Smile Partners PLLC
99 Wall Street, NY, NY 10005
Phone: (971) 999-3399 | Email: talk@yoursmilepartners.com
Phone: (971) 999-3399 | Email: talk@yoursmilepartners.com
Patient Information
Insurance Benefits
$
$
$
$
Default Coverage
%
%
%
Treatment Selection
Loading procedures...
Interactive Chart
Tip: Click a treatment row to activate it, then select teeth on the chart to fill its Tooth/Area.
Treatment Plan
| CDT | Description | Tooth/Area | Fee | Coverage | Net Fee (Patient) | Action |
|---|
Fee Summary
Total Treatment Fees:$0.00
Patient Deductible:$0.00
Total Insurance Payment:$0.00
Patient Estimated Portion:$0.00
Patient Signature
Dentist Signature
RDH Signature