To specify the status of individual teeth
| Position | Element | Name | Type | Min/Max | Repeat | |
|---|---|---|---|---|---|---|
| 1 | 127  | Reference Identification | Mandatory | Alphanumeric | 1/80 | AtMax 1 | 
| 2 | 1368  | Tooth Status Code | Opt | ID | 1/2 | AtMax 1 | 
| 3 | 380  | Quantity | Opt | Decimal | 1/15 | AtMax 1 | 
| 4 | 1250  | Date Time Period Format Qualifier | Rel | ID | 2/3 | AtMax 1 | 
| 5 | 1251  | Date Time Period | Rel | Alphanumeric | 1/35 | AtMax 1 | 
| 6 | 1270  | Code List Qualifier Code | Mandatory | ID | 1/3 | AtMax 1 |