Monetary amount.

SV302 is submitted charge amount.

Code identifying the type of facility where services were performed; the first and second 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

SV303 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.

SV304 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.

SV308 is number of procedures.

A free-form description to clarify the related data elements and their content.

SV309 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