Dr.

The Van Chau Dentist

Munichwiesen 2 - 55566 Bad Sobernheim Tel. 06751-5007

Cha mini meshing 2- 55566 Bath Sobembere Herm Phone: 06751-S007

John Roa Hinterhausen 20a Fax: 06751-854788 55571 Odernheim am Glan. 1/3856/1 U

invoice date Untilitum: (specify in case of bice) 10.12.2019

Treated person: John Roa Date of birth: 24.06.1995 10.12.19-10.12.19 Pont 300.Derar

Dear Mr. Roa, for the dental treatment I allow myself to calculate for the provisions applicable at the
time: BGR. Factor Ana. 2.3 2.3 2.3 EUR Leveling / Dispositions Advice, also by means of a telephone
symptom-related investigation Intraoral surface anesthetic, the jaws or frozen area Intraoral
conductivity resides Intraoral infiltration analysts Date Region No. 10.12.19 Ai 10,72 10,72 3,88 AS 45
0080 45 0100 2,3 9,05 45 0090 2,3 7,76 Extritation of the vital Pulpa incl. Excavation, the channel of
treatment of a root channel also retrograde, the channel, given failure in several sessions Special
measures in preparing or fouls of cavitations, the jaw or orders of accessories Additional availability
Electrophysical-chemical methods, the channel Electrometric length determination of a root canal drug
inserts in connection Mt achievements after 45 2360 2.3 14.23 45 2410 2,3 50,71 45 2030 2,3 8,41 45
2420 2,3 9,05 2,3 2,3 45 2420 2,19,04 2,3 2,3,44,200 24,320, 9,10 45 2430 1.23 45 2400 2,19, 45,320,
24,34,3204220, 2,3 9,05 2,3 2,3,43,204200, 2,3 9,05 2,3 2,3,43,24 24,00 2,19,424 24,300.4.4.4.20 45.20,
2.3 9.05 2,3 2,3 45 2420 2.3 9,05 2,3 2,34 24 24 2,14, 9,35 24,300.4.4.4.20 24.20. Tochered E KTO 020
6000 827-BLZ 300 606 01 Iban: DES8300606010206000827 BICI DAEDEDDIOX PAGE I OF 2 OCR Sign Crop
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The Van Chau Dentist

Munichwiesen 2- 55566 Bad Sobernheim Tel. 06751-5007

10.12.2019

Bill for: Mr John Roa, b. On: 24.06.1995 BGR. Factor Arz. EUR / DEPORATIces Number 2360 to 2380 and
2410, the teeth and session Temporary memory sample Closure of a Cavitate Date Region No. 45 2020
2.3 12.68 Total fee: 181.70

1,50 10.12.19 54 (3) Septestest 1: 200,000, the ampoule to the boost cost price costs for expenses after
5 3.4 Goz and 5 10 Goa: invoice amount: 1.50 183, barcodes Beaten at the bill Agefine DTAN. The
calculation of the fee benefits is the fee for dental district (GOZ) of 01.01.2012 and the bulletin
regulations for Doctor (Goa) from 01.01.96. This invoice is payable until 24/12/2019. If the invoice
amount is transferred, please enter the invoice number. Further versions As far as column justifications'
(BGR.) Labeling has been set FEL DESIFS ATS AWARDS FIND AT 53, A GOZ and 510 GOA BGR. A) Dr The
Van Chau Litinchecen Cibe Bbershem Tefos 5-500 Fuuef 067548547 Berag 830 € Daulde Stidlsh, 10.
12.18 AP HMO Deutscte Apotheter U ARSTEBKARK EC - KO 020 6000 827 -Z 300 06 01 RAN
DES300606010206000827 BIC: DAEDEDCI

Page 2 on the date of 10/12/2019

Dr. The Van Chau Dentist

Münchwiesen 2 – 55566

Bad Sobernhelm Tel. 06751-5007

Dr. Cheu - Minchraiesen 2 - 55566 Bed Soberheim

Mr. John Roa Phone: 06751-5007 Hinterhausen 20a Fax: 06751-854788 55571 Odernheim am Glan
Invoice Invoice number: (please state when paying) 1/3856/2 Invoice date: 18.12.2019

Treated person: John Roa Date of birth: 24.06.1995 Zentrum: 17.12.19

Dear Mr. Roa, for the dental treatment I allow myself to calculate according to the currently applicable
regulations:

Date Region No. 17.12.19 Service description / expenses Special measures at Preparation or filling of
cavities, depending on jaw jaws or anterior tooth area Bgr. Factor number . EUR 45 2030 2.3 1. 8.41 45
2420 Additional application of electraphysical-chemical methods, per channel Electrometric length
determination of a root canal Filling of a root canal 2.3 9.05 45 2400 2.3 18.10 45 2440 3.5 50, 79 45
AS000 Radiation Diagnostics Teeth, each projection 1.8 2.3 5.24 45 2030 Special measures when
preparing or filling cavities, each half of the jaw or anterior tooth area 8.41 45 2100 Preparing a cavity
and restoration with composite materials, using adhesive technology (conditioning) , triple, possibly
including multi-layer technology, including polishing, possibly including use of inserts Adhasive
attachment (plastic structure, pin, inlay, crown, telephoto crown, veneer, etc.)

3.5 126.38 45 2197 2.3 16.82 Germans Pharmacists Arztebark eG. - Kto 020 6000 827 - BLZ 300 606 01
IBAN: DES8300606010205000827 BIC: DAAEDEDDXXX Page 1 of 2 OCR Sign Crop Recognize Retake Filter
(2)

Page 1 on the date of 17/12/2019

Dr. The Van Chau Dentist

Münchwiesen 2-55566 Bad Sobernheim Tel. 06751-5007

invoice for: Herm John Roa (On: 24.06.1995)

18.12.2019 Double sum: 503.20 Invoice amount: 243. 20

Berodes Etatan AF Oering Profit Autumnedent Datan. The calculation of the fee benefits is the fee for
dentists (GOZ) from 01.01.2012 and de FOR MRJECTION FOR PART (GOA) from 01.01.96. This invoice is
payable until 0101.2020. For the order of the invoice amount, please indicate the invoice number. OCR
Sign Crop Recognize Retake Filter (2)

Page 2 on the date of 17/12/2019