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Expenses

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    • Expense Summary
    Expense Summary Total Expenses Total Paid Expenses Total Unpaid Expenses
      $23.32 Total expenses tooltip $4.50 Total paid expenses tooltip $18.82 Total unpaid expenses tooltip

    Total Eligible to Submit: $12.50 Total eligible to submit tooltip



    01/01/2019 - 12/31/2019 Summary
    Date Expense RECIPIENT/PATIENT MERCHANT/PROVIDER SUBMITTED AMOUNT Status
    		MM/DD/YYYY Dental Demo User Johnson Dental Clinic $12.50
    Pay
    Expense Details
    Description:
    Cavity Filling
    Source:
    Online
    Expense Amount:
    $12.50
    Payable Amount:
    $12.50
    Date(s) of Service:
    MM/DD/YYYY
    Total Billed Amount:
     Total billed amount tooltip $12.50
    Received Date:
    MM/DD/YYYY
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    		MM/DD/YYYY Pharmacy Demo User CVS $4.50 Paid
    Expense Details
    Description:
    Prescription
    Source:
    Online
    Expense Amount:
    $4.50
    Date(s) of Service:
    1/18/2019
    Total Billed Amount:
     Total billed amount tooltip $4.50
    Received Date:
    1/23/2019
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    Payment Details
    Description:
    Distribution
    Requested On:
    1/23/2019
    Expense Category:
    Pharmacy
    Source:
    Online
    Date(s) of Service:
    1/23/2019
    Account:
    Health Savings Account
    Paid:
    $4.50
    		MM/DD/YYYY Dental Demo User Johnson Dental Clinic $6.32
    Expense Details
    Description:
    Dental Clearning
    Source:
    Online
    Expense Amount:
    $6.32
    Date(s) of Service:
    1/14/2019
    Total Billed Amount:
     Total billed amount tooltip $6.32
    Received Date:
    1/18/2019
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    Payment Details
    Date(s) of Service:
    1/14/2019 - 1/14/2019
    Requested On:
    1/18/2019
    Expense Category:
    Dental
    Denied:
    $6.32
    Claim Number:
    356895190118P0000101
    Account:
    Limited Purpose FSA
    Source:
    Online
    Receipt Status:
    Uploaded
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