Monetary amount

SV302 is the submitted service line item amount.

Code identifying where services were, or may be, performed; the National Uniform Billing Committee (NUBC) Facility Type Code for Institutional Services or the Place of Service Codes for Professional or Dental Services.

SV303 is the place of service code representing the location where the dental treatment was rendered.

Code specifying the placement status for the dental work

Numeric value of quantity

SV306 is the number of procedures.

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

SV307 is the 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

Code indicating a Yes or No condition or response

SV310 is the predetermination of benefits indicator. A "Y" value indicates that this service is being submitted for predetermination of benefits.

A pointer to the diagnosis code in the order of importance to this service

The first pointer designates the primary diagnosis and remaining diagnosis pointers indicate declining level of importance.