SV3 Dental Service
To specify the claim service detail for dental work
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
Identifying number for a product or service.
SV303 is submitted charge amount.
Code identifying the type of facility where services were performed; the first position of the uniform bill type or place of service from health care financing administration claim form or place of treatment from the dental claim form
SV304 is place of service or treatment.
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
SV305 is tooth number.
Code identifying the area of the tooth that was treated
Code identifying the dental quadrant of the mouth in which service is rendered
Code specifying the placement status for the dental work
Numeric value of quantity.
SV309 is number of procedures.
A free-form description to clarify the related data elements and their content.
SV310 is reason for replacement.
Code indicating whether or not co-payment requirements were met on a line by line basis
Code indicating the type of agreement under which the provider is submitting this claim