Invoice Dentist in France Paris –Free Word Template Download with AI
Dr. Antoine Dubois, D.D.S.
12 Rue de Rivoli, 75004 Paris, France
Tel: +33 1 42 72 12 34
Email: [email protected]
SIRET: 852 963 741 00012
Invoice Number: INV-2023-10-045
Date of Issue: October 15, 2023
Due Date: October 30, 2023
Payment Terms: Net 15 Days
Billed To (Patient)
Mr. Jean-Pierre Martin
45 Avenue de la République
75011 Paris, France
SS Number: 1 85 04 75 112 345 67
Complementary Insurance: Mutuelle Santé Plus
Service Details
Appointment Date: October 10, 2023
Treating Dentist: Dr. Antoine Dubois
Procedure Code: NAF 86.23Z
Base Fee Reference: Nomenclature Actes Professionnels Dentaires (NAPD)
| Description of Dental Services | Code | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|
| Comprehensive Oral Examination and Diagnosis | 101 | 1 | 45.00 | 45.00 |
| Full Mouth Radiographic Series (Panoramic X-Ray) | 205 | 1 | 60.00 | 60.00 |
| Professional Dental Cleaning (Prophylaxis) | 302 | 1 | 85.00 | 85.00 |
| Composite Resin Filling (Tooth #16) | 403 | 1 | 120.00 | 120.00 |
| Root Canal Therapy (Tooth #16) | 507 | 1 | 350.00 | 350.00 |
| Temporary Crown Placement | 601 | 1 | 75.00 | 75.00 |
| Local Anesthesia Administration | 702 | 2 | 15.00 | 30.00 |
| Post-Treatment Consultation and Follow-Up | 801 | 1 | 35.00 | 35.00 |
Important Notes Regarding This Invoice
This invoice is issued in accordance with French dental regulations and the National Health Insurance (Assurance Maladie) guidelines. The fees listed are based on the official fee schedule (NAPD) with applicable honoraires libres (free fees) where permitted. The patient is responsible for the remaining balance after insurance reimbursement. Please retain this document for your records and submit it to your complementary health insurance provider (Mutuelle) for further reimbursement. Payment can be made via bank transfer, credit card, or cash at our clinic in Paris. For any questions regarding this invoice or your dental treatment, please contact our office directly.
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