Pre-Treatment Details
Member
{{memberName}}
Relationship
{{relationship | lowercase}}
Dentist
{{dentist}}
Date Received
{{dateReceived | date:'MM/dd/yyyy'}}
Status
{{status | lowercase}}
Date Processed
{{dateProcessed | date:'MM/dd/yyyy'}}
Your Responsibility
{{responsibilityAmt | currency}}
-
Procedure Code{{list.procedureCode}}{{list.procedureDesc}}Tooth Number{{list.toothNumber}}Submitted Charge{{list.submittedCharges | currency}}Allowed{{list.allowedAmt | currency}}Deductible{{list.deductibleAmt | currency}}Benefit Amount{{list.benefitAmt | currency}}
