Bright Smile Dental Receipt Example
This is a sample Bright Smile Dental receipt showing Adult Cleaning (Prophylaxis), Periodic Exam and 1 more item, with a total of $240.00. Use it as a reference for what a real Bright Smile Dental receipt looks like — then make your own with your items, prices, date and store details.
What's on this receipt
| Item | Qty | Price |
|---|---|---|
| Adult Cleaning (Prophylaxis) | 1 | $120.00 |
| Periodic Exam | 1 | $55.00 |
| Bitewing X-rays | 1 | $65.00 |
| Total (incl. tax) | $240.00 | |
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SALES RECEIPT
Bright Smile Dental
330 Wellness Avenue
San Jose, CA 95128
(612) 555-0137
06/15/2026 13:42 · Receipt #745321
Store # 100Reg 1
| Item | Qty | Price | Total |
|---|---|---|---|
| Adult Cleaning (Prophylaxis) | 1 | $120.00 | $120.00 |
| Periodic Exam | 1 | $55.00 | $55.00 |
| Bitewing X-rays | 1 | $65.00 | $65.00 |
Subtotal$240.00
TOTAL$240.00
Payment MethodCredit •••• 4821
Thank you. Please keep this receipt for your records.
745321