What is the total amount paid by check? (Fill in the Amt paid provider column before calculating the total.)

Patient's name	Amt paid provider
Kavan, Gregory	$
Ferrara, Grace	$
Cornprost, Harry	$
Total

Date prepared: 6/22/2029 Claim number: 0347914 Patient's name Dates of service POS Proc Qty Charge Eligible Patient Amt paid from - thru amount amount liability provider Kavan, Gregory 04/15/29 - 04/15/29 11 99213 1 $48.00 $48.00 $4.80 Ferrara, Grace 05/11/29 - 05/11/29 11 99212 1 $35.00 $35.00 $3.50 Cornprost, Harry 05/12/29 - 05/12/29 11 99214 1 $64.00 $54.00 -0- Vanderhilt, Gloria 05/12/29 - 05/12/29 11 99212 1 $35.00 $35.00 $35.00 Dallez, Juan 05/13/29 - 05/13/29 11 99212 1 $35.00 ******** Check #1039242 is attached in the amount of * Procedure not covered under Medicaid