Invoice Orthodontist in Germany Berlin –Free Word Template Download with AI
Specialized Orthodontic Practice
Kurfürstendamm 185
10707 Berlin, Germany
Tel: +49 30 1234 5678
Email: [email protected]
USt-IdNr.: DE123456789
Kammer-Nr.: 12345
Invoice No: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Reference: Treatment Plan Phase II
Bill To (Insurance / Payer)
AOK Berlin
Invalidenstraße 158
10115 Berlin, Germany
Insurance ID: AOK-BER-987654321
Patient Details
Name: Max Mustermann
Date of Birth: 15.05.2010
Address: Friedrichstraße 100, 10117 Berlin
Case Number: OM-2023-089
| No. | Description of Orthodontic Services | GOZ / Code | Factor | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 1 | Initial comprehensive orthodontic examination in Berlin, including panoramic X-ray analysis and cephalometric evaluation to determine malocclusion severity. | 01010 | 2.3 | 45.00 | 103.50 |
| 2 | Creation of diagnostic models and study casts for treatment planning. Essential for the precise alignment strategy required for complex cases in our Berlin clinic. | 01020 | 2.0 | 30.00 | 60.00 |
| 3 | Application of fixed orthodontic appliance (braces) on the upper jaw. Includes bonding of brackets and archwire insertion according to German medical standards. | 05010 | 3.5 | 150.00 | 525.00 |
| 4 | Application of fixed orthodontic appliance (braces) on the lower jaw. Comprehensive bonding procedure ensuring optimal force distribution. | 05010 | 3.5 | 150.00 | 525.00 |
| 5 | Monthly adjustment appointment. Includes wire changes, ligature replacement, and progress monitoring. This invoice covers the adjustment for October 2023. | 05030 | 2.0 | 60.00 | 120.00 |
| 6 | Intermaxillary elastics prescription and fitting. Used to correct bite discrepancies as part of the ongoing treatment in our Berlin facility. | 05040 | 1.5 | 25.00 | 37.50 |
| 7 | Intraoral radiographic control (Bitewing). To monitor root health and bone levels during active orthodontic movement. | 03010 | 2.0 | 40.00 | 80.00 |
| 8 | Professional prophylaxis and cleaning around orthodontic brackets. Crucial for preventing decalcification and gingivitis during treatment in Germany. | 01710 | 2.5 | 55.00 | 137.50 |
Payment Terms and Legal Information
Payment Method: Please transfer the total amount due to our bank account within 30 days of the invoice date. Late payments may incur interest charges in accordance with German commercial law (BGB § 288).
Bank Details:
Bank: Berliner Sparkasse
IBAN: DE89 1005 0000 1234 5678 90
BIC: BELADEBEXXX
Account Holder: Dr. Elena Weber Orthodontic Practice
Insurance Note: This invoice reflects the costs associated with the orthodontic treatment plan approved for the patient. The deduction represents the portion covered by the statutory health insurance (AOK Berlin). The remaining balance is the patient's private contribution (Zuzahlung) or the cost of services exceeding the standard insurance catalog.
Data Protection: In compliance with the General Data Protection Regulation (GDPR) applicable in Germany and the EU, your personal and medical data is processed solely for the purpose of treatment and billing. We ensure the highest standards of confidentiality.
Orthodontic Care in Berlin: Our practice adheres to the strict guidelines set by the German Association of Orthodontists (Deutsche Gesellschaft für Orthodontie und Kieferorthopädie). Regular attendance at appointments is vital for the success of the treatment. Please contact our office in Berlin immediately if you need to reschedule.
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