The image appears to be a photocopied receipt or invoice from a dental office. At the top, there is text that seems to indicate it's a document related to dental services or billing. There are tables with numbers and items listed under "DESCRIPTION OF SERVICES" and "SERVICE CODE" columns. On the right side of the page, there are handwritten notes, including what looks like a signature at the bottom right corner. The visible text includes terms commonly associated with dental care, such as "DENTAL EXAM" and "ORAL RADIOGRAPH (X-RAY)." There is also a date in numerical form near the top of the page.