ADP
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Denver Optic Ocular Prosthetic Company
VENDOR
103037
2018261
2022589
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Service Name
Device Code
Billed
Allowed
Patient
Service Name
Device Code
OPRCF
Billed $
Allowed $
Patient $
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Health Card Number *
Service Type *
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Service Date *
Invoice #
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Eye Side *
L Left
R Right
Bill Type *
REG — Regular
ODS
ACS
OWP
Device Code (auto)
Billed Amount (auto)
Patient Resp. (auto)
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103037_YYYY-MM-DD.txt
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