Add New Collection CollectionsPatient NameDate of BirthPhone/WhatsAppEmailProcedure- Select procedure -Dental ExaminationDental ConsultationDental BracesClear AlignersRoot Canals TreatmentTooth ExtractionsWisdom Teeth RemovalDental VeneersTeeth WhiteningCometic BondingTeeth Cleaning (SRP)Full Mouth RehabilitationDental Implant SurgeryFull Mouth Dental ImplantsFixed vs Removable TeethRemovable/Snap-in DenturesDental CrownsDental BridgeIV SedationBone And Soft Tissue GraftingTreatment Of Implant FailurePeriodontal SurgeryEmergency Dental CareZoom Teeth Whitening (DISC30)OtherProcedure DateInsurance- Select insurance -Atena-PPDStandard-PPDGuardian-PPDCigna-PPDTeam Care-PPDMetlife-PPDHumana-PPDUnited Concordia-PPDUnited Health Care - PPDBCBS-PPDAmerica's-PPDDelta Dental-PPDPrincipal-PPDEnvolveTMHPDenta QuestMCNAChipLibertyQEHAUnited Health Care DualUHC Medi For KidsTricare-VAOtherBilled Amount$Payable Balance$Billing DatePayment- Select payment-CashCardCollected Amount$Collection DateRemaining Balance$SubmitThis site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. PATIENTS Log In Collections insurance details Collections
