Maplewood Dental Care
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Jordan Rivera
jordan.rivera@example.com

Hi, Jordan

Here's an overview of your account and recent statements.

CURRENT BALANCE
$248.50
Due July 22, 2026
Autopay
Automatically pay new statements on the due date

Statements & invoices

StatementAmountStatus
Crown — tooth #14
INV-20418 · Jun 28, 2026
$180.00
Due
Cleaning & exam
INV-20390 · Jun 10, 2026
$68.50
Due
Dental X-rays (bitewing)
INV-20221 · Apr 03, 2026
$95.00
Paid
Composite filling — tooth #19
INV-20105 · Feb 17, 2026
$142.00
Paid

Payment methods

Visa ending 4242
Expires 08 / 27 · Default
Default

Payment history

Dental X-rays
Apr 03, 2026 · Visa 4242
$95.00
Paid
Composite filling
Feb 17, 2026 · Visa 4242
$142.00
Paid

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Maplewood Dental Care
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Order summary

    Subtotal$248.50
    Processing fee$0.00
    Total due $248.50
    Encrypted & processed securely by SecurePay
    Maplewood Dental Care
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    Payment successful

    Thank you. A receipt has been emailed to you.

    $248.50
    Confirmation numberSP-7F3K-92A0
    Date & timeJul 7, 2026, 2:14 PM
    Payment methodVisa ending 4242
    Paid toMaplewood Dental Care
    Statement(s)Account balance

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