| J20104C017 | 2010420030... | 0 | | Q503: Dentistry Services | $6,392.00 | 2003 | 3203277 |
| J20104C017 | 0 | | Q503: Dentistry Services | $0.00 | 2003 | 3207081 |
| J20104C017 | DJBALM4B13... | 0 | | Q503: Dentistry Services | $2,405.00 | 2004 | 3257736 |
| J20104C017 | DJBALM4B13... | 0 | | Q503: Dentistry Services | $1,332.00 | 2004 | 3259173 |
| J20104C017 | DJBALM4B13... | 0 | | Q503: Dentistry Services | $1,998.00 | 2004 | 3940817 |
| J20104C017 | DJBALM4B13... | 0 | | Q503: Dentistry Services | $2,516.00 | 2004 | 3980553 |
| J20104C017 | DJBALM4B13... | 0 | | Q503: Dentistry Services | $2,368.00 | 2004 | 4083306 |
| J20104C017 | DJBALM4B13... | 0 | | Q503: Dentistry Services | $2,368.00 | 2004 | 4143697 |
| J20104C017 | DJBALM4B13... | 0 | | Q503: Dentistry Services | $2,090.50 | 2004 | 4195593 |
| J20104C017 | DJBALM4B13... | 0 | | Q503: Dentistry Services | $1,961.00 | 2004 | 4250721 |
| J20104C017 | DJBALM4B13... | 0 | | Q503: Dentistry Services | $2,220.00 | 2004 | 4271356 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $2,400.00 | 2005 | 5259913 |
| J20104C017 | DJBALM5B13... | 1 | | Q503: Dentistry Services | ($375.00) | 2005 | 5292252 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $2,550.00 | 2005 | 5363158 |
| J20104C017 | DJBALM5B13... | 1 | | Q503: Dentistry Services | $0.00 | 2005 | 5433831 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $2,362.50 | 2005 | 5531495 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $2,550.00 | 2005 | 5740055 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $2,512.50 | 2005 | 5808817 |
| J20104C017 | DJBALM5B13... | 2 | | Q503: Dentistry Services | ($187.50) | 2005 | 5916999 |
| J20104C017 | DJBALM5B13... | 1 | | Q503: Dentistry Services | ($56.25) | 2005 | 6535656 |
| J20104C017 | DJBALM5B13... | 1 | | Q503: Dentistry Services | ($168.75) | 2005 | 6558687 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $2,257.00 | 2005 | 6849344 |
| J20104C017 | DJBALM5B13... | 1 | | Q503: Dentistry Services | ($37.00) | 2005 | 6946459 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $2,250.00 | 2005 | 6991755 |
| J20104C017 | DJBALM5B13... | 1 | | Q503: Dentistry Services | ($113.00) | 2005 | 7134957 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $1,987.50 | 2005 | 7231961 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $2,250.00 | 2005 | 7418819 |
| J20104C017 | DJBALM5B13... | 1 | | Q503: Dentistry Services | ($18.75) | 2005 | 7489047 |
| J20104C017 | DJBALM5B13... | 1 | | Q503: Dentistry Services | ($112.50) | 2005 | 7777409 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $2,550.00 | 2005 | 7884317 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $2,362.50 | 2005 | 7935138 |
| J20104C017 | DJBALM5B13... | 0 | | Q503: Dentistry Services | $2,259.00 | 2005 | 8056375 |
| J20104C017 | DJBALXFB15... | 1 | | Q503: Dentistry Services | ($1,007.00) | 2006 | 8273933 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $2,945.00 | 2006 | 8368304 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $3,097.00 | 2006 | 8498153 |
| J20104C017 | DJBALXFB15... | 1 | | Q503: Dentistry Services | ($351.50) | 2006 | 8552734 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $2,660.00 | 2006 | 8552766 |
| J20104C017 | DJBALXFB15... | 1 | | Q503: Dentistry Services | ($142.50) | 2006 | 8743052 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $2,907.00 | 2006 | 8743071 |
| J20104C017 | DJBALXFB15... | 1 | | Q503: Dentistry Services | ($408.50) | 2006 | 8932817 |
| J20104C017 | DJBALXFB15... | 1 | | Q503: Dentistry Services | ($199.50) | 2006 | 8973229 |
| J20104C017 | DJBALM5B13... | 1 | | Q503: Dentistry Services | ($93.75) | 2006 | 9126090 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $2,587.50 | 2006 | 9257081 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $2,250.00 | 2006 | 9460966 |
| J20104C017 | DJBALXFB15... | 1 | | Q503: Dentistry Services | ($187.50) | 2006 | 9639382 |
| J20104C017 | DJBALXFB15... | 2 | | Q503: Dentistry Services | ($123.50) | 2006 | 9761687 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $2,812.00 | 2006 | 10165351 |
| J20104C017 | DJBALXFB15... | 1 | | Q503: Dentistry Services | $37.00 | 2006 | 10377832 |
| J20104C017 | DJBALXFB15... | 1 | | Q503: Dentistry Services | ($104.50) | 2006 | 10498464 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $2,831.00 | 2006 | 10597619 |
| J20104C017 | DJBALXFB15... | 1 | | Q503: Dentistry Services | ($209.00) | 2006 | 10775954 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $2,603.00 | 2006 | 10961350 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $2,717.00 | 2006 | 11151955 |
| J20104C017 | DJBALXFB15... | 1 | | Q503: Dentistry Services | ($294.50) | 2006 | 11371678 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $3,049.50 | 2006 | 11475622 |
| J20104C017 | DJBALXFB15... | 1 | | Q503: Dentistry Services | ($57.00) | 2006 | 11619432 |
| J20104C017 | DJBALXFB15... | 0 | | Q503: Dentistry Services | $3,097.00 | 2006 | 11831640 |
| J20104C017 | 4 | | Q503: Dentistry Services | $0.00 | 2006 | 11918557 |
| J20104C017 | DJBALXGB15... | 0 | | Q503: Dentistry Services | $2,850.00 | 2007 | 15794409 |
| J20104C017 | DJBALXGB15... | 0 | | Q503: Dentistry Services | $2,641.00 | 2007 | 15876141 |