SV3 Dental Service
Opt
AtMax 1
To specify the claim service detail for dental work
Elements
| Position | Element | Name | Type | Min/Max | Repeat | ||
|---|---|---|---|---|---|---|---|
Exact 1 | |||||||
| 2 | 782 | Monetary Amount | Opt | Decimal | 1/18 | Exact 1 | |
| 3 | 1331 | Facility Code Value | Opt | Alphanumeric | 1/2 | Exact 1 | |
Exact 1 | |||||||
| 5 | 1358 | Prosthesis, Crown or Inlay Code | Opt | ID | 1/1 | Exact 1 | |
| 6 | 380 | Quantity | Opt | Decimal | 1/15 | Exact 1 | |
| 7 | 352 | Description | Opt | Alphanumeric | 1/80 | Exact 1 | |
| 8 | 1327 | Copay Status Code | Opt | ID | 1/1 | Exact 1 | |
| 9 | 1360 | Provider Agreement Code | Opt | ID | 1/1 | Exact 1 | |
| 10 | 1073 | Yes/No Condition or Response Code | Opt | ID | 1/1 | Exact 1 | |
Exact 1 | |||||||
Element Details
ID782
NameMonetary Amount
LengthMin 1 / Max 18
Position2
RequirementOpt