Your Practice Name (56E) VSS Medical Office System Printed: 02/24/03 SUBMISSION SUMMARY REPORT Page: 1 Selected: 02/25/1998 - 02/24/2003 Date How Batch Number of Claims Total Charges -------------------------------------------------------------------------------- 05/19/99 Selected Claim 1 135.00 ------------ ------------- Totals for 05/19/99 1 $ 135.00 -------------------------------------------------------------------------------- 11/14/00 Selected Claim 1 245.00 ------------ ------------- Totals for 11/14/00 1 $ 245.00 -------------------------------------------------------------------------------- 03/13/01 Patient Statement 32 1615.28 ------------ ------------- Totals for 03/13/01 32 $ 1615.28 -------------------------------------------------------------------------------- 02/12/02 Selected Claim 1 1045.00 ------------ ------------- Totals for 02/12/02 1 $ 1045.00 -------------------------------------------------------------------------------- 02/20/02 Patient Statement 29 1633.22 ------------ ------------- Totals for 02/20/02 29 $ 1633.22 -------------------------------------------------------------------------------- 04/19/02 Patient Statement 9 493.46 ------------ ------------- Totals for 04/19/02 9 $ 493.46 --------------------------------------------------------------------------------