Invoice Dentist in France Lyon –Free Word Template Download with AI
Cabinet Dentaire Associé
Specialists in Orthodontics & Implantology
Invoice Number: LD-2023-10-894
Date of Issue: October 24, 2023
Due Date: November 24, 2023
From (Provider)
Dr. Jean-Pierre Moreau & Associates
15 Rue de la République
69002 Lyon, France
Tel: +33 4 72 00 00 00
Email: [email protected]
SIRET: 123 456 789 00012
N° TVA Intracommunautaire: FR 12 123456789
Bill To (Patient)
Mr. Thomas Dubois
42 Avenue Jean Jaurès
69007 Lyon, France
Tel: +33 6 12 34 56 78
Email: [email protected]
Sécurité Sociale N°: 1 89 02 69000 123 45
Mutuelle: Groupama Santé Premium
Dear Mr. Dubois,
This document serves as the official Invoice for the dental services rendered at our practice in Lyon, France. As a leading Dentist provider in the Rhône-Alpes region, we are committed to providing transparent billing in accordance with French healthcare regulations. The following items detail the procedures performed during your recent visit, including diagnostic imaging, restorative work, and specialized care. Please review the details carefully. This invoice is generated to facilitate your reimbursement process with both the French National Health Insurance (Assurance Maladie) and your complementary private insurance (Mutuelle).
| Code (Nomenclature) | Description of Dental Services | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|
| 70101 |
Comprehensive Clinical Examination Initial consultation including oral health assessment, periodontal screening, and discussion of treatment plan. Performed by Dr. Moreau. |
1 | 25.00 | 25.00 |
| 70201 |
Diagnostic Radiography (Panoramic) Digital panoramic X-ray to assess bone structure and tooth alignment. Essential for planning the subsequent restorative work in the lower jaw. |
1 | 35.00 | 35.00 |
| 70202 |
Periapical Radiographs (Set of 4) Detailed X-rays of specific teeth to evaluate root canal health and periapical tissues. |
1 | 20.00 | 20.00 |
| 80201 |
Prophylaxis (Teeth Cleaning) Ultrasonic scaling and polishing to remove plaque and tartar buildup. Includes fluoride application for enamel strengthening. |
1 | 45.00 | 45.00 |
| 80501 |
Composite Resin Filling (Class II) Restoration of tooth #36 (Lower Left First Molar). Removal of carious tissue and placement of aesthetic composite material. Includes bonding agent and curing. |
1 | 120.00 | 120.00 |
| 80502 |
Composite Resin Filling (Class V) Restoration of tooth #11 (Upper Right Central Incisor) for cervical erosion. Aesthetic matching to natural tooth shade. |
1 | 95.00 | 95.00 |
| 80601 |
Root Canal Treatment (Single Root) Endodontic therapy for tooth #45. Includes access opening, cleaning, shaping, and obturation of the root canal system. Performed under local anesthesia. |
1 | 250.00 | 250.00 |
| 80701 |
Provisional Crown Temporary restoration placed on tooth #45 following root canal treatment to protect the tooth structure while the permanent crown is fabricated. |
1 | 60.00 | 60.00 |
| 80801 |
Local Anesthesia Administration of lidocaine with epinephrine for pain management during operative procedures. |
1 | 15.00 | 15.00 |
| 90101 |
Prescription & Medication Antibiotics (Amoxicillin) and analgesics prescribed for post-operative care following root canal therapy. |
1 | 12.00 | 12.00 |
| Subtotal (HT) | 677.00 € |
| VAT (TVA) - Rate 2.1% (Healthcare) | 14.22 € |
| Total Amount Due (TTC) | 691.22 € |
Payment Instructions & Important Information
Payment Methods: We accept cash, major credit cards (Visa, Mastercard), and direct bank transfer (SEPA).
Bank Details:
Bank: Crédit Lyonnais
IBAN: FR76 3000 4000 0100 0000 0000 000
BIC: CRLYFRPP
Reference: Invoice LD-2023-10-894
Reimbursement (Remboursement):
As per French regulations, this invoice includes the necessary codes for the "Feuille de Soins Électronique" (FSE). Your care has been electronically transmitted to the CPAM Lyon. You will receive reimbursement from the Assurance Maladie within 7-10 days. Please forward this invoice to your Mutuelle for any remaining balance coverage.
Late Payment:
Payment is due within 30 days of the invoice date. A late fee of 3 times the legal interest rate plus a fixed penalty of €40 may be applied for overdue amounts.
Legal Notice:
This document is issued in accordance with the French Public Health Code (Code de la Santé Publique) and the General Tax Code (Code Général des Impôts). Lyon Dental Excellence is a registered healthcare provider in the Auvergne-Rhône-Alpes region.
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