EDI Dictionary

Transaction Sets Segments

EDI-Dictionary

4010

SV3

SV3 Dental Service

Batch

To specify the claim service detail for dental work

Elements

Position	Element	Name		Type	Min/Max	Repeat

C003Composite Medical Procedure IdentifierMandatory 1
2	782	Monetary Amount	Opt	Decimal	1/18	1
3	1331	Facility Code Value	Opt	Alphanumeric	1/2	1
C006Oral Cavity DesignationOpt 1
5	1358	Prosthesis, Crown or Inlay Code	Opt	ID	1/1	1
6	380	Quantity	Opt	Decimal	1/15	1
7	352	Description	Opt	Alphanumeric	1/80	1
8	1327	Copay Status Code	Opt	ID	1/1	1
9	1360	Provider Agreement Code	Opt	ID	1/1	1
10	1073	Yes/No Condition or Response Code	Opt	ID	1/1	1
C004Composite Diagnosis Code PointerOpt 1

Element Details

ID782

NameMonetary Amount

LengthMin 1 / Max 18

Position2

RequirementOpt