Segment
X12 EDI Release 00504
To specify the service line item detail for dental work
Elements
Code identifying the type/source of the descriptive number used in Product/Service ID (234)
Codes (511)- 00Credit Card
- A1Plant Equipment Number
- A2Department of Defense Identification Code (DoDIC)
- A3Locally Assigned Control Number
- A4Subsistence Identification Number
- A5Application State or Province
- A6Document Identification Code
- A7Subline Item Number
- A8Exhibit Line Item Number
- A9Activity
- AAAssembly Level Code, Vehicle Maintenance Reporting Standards (VMRS) 2000 Code Key 32
- ABAssembly
- ACAggregation Code (Used to Consolidate Part Families)
- ADAmerican Dental Association Codes
- AESerial Item and Contribution Identifier (Defined in ANSI 239.56)
- AFFront Axle Serial Number
- AGAge
- AHBillboards Commercial
- AIAlternate ISBN
- AJPiggyback Commercial
- AKRefined Product Code
- ALAxle Serial Number
- AMAllocation Methodology Identification Code
- ANAsset Number
- APComponent Level Code, Vehicle Maintenance Reporting Standards (VMRS) 2000 Code Key 33
- AQAppraisal Product Type
- ARARINC Part Number
- ASRear Axle Serial Number
- ATAssortability Code
- AUAppraisal Service
- AVAdditional Product Identification Assigned by the Manufacturer
- AWWell Number
- AXAssembly Lot Number
- AYSystem Level Code, Vehicle Maintenance Reporting Standards (VMRS) 2000 Code Key 31
- AZAxle Ratio
- B1Volume Set
- B2Library of Congress Code
- B3Edition Code
- B4Binding Code
- B5Title Code
- B6Author Code
- B7Publisher Code
- B8Batch Number
- B9Front Axle Driven Serial Number
- BABale Number
- BBPrint Color Standard Reference
- BCSupplier Brand Code
- BDBuyer Ground Shade Identifier
- BEBuyer's Engineering Change Level Number
- BFVendor Ground Shade Identifier
- BGGround Shade Standard Reference
- BHFinish/Hand Standard Reference
- BIRear Axle Rear Non Driven Serial Number
- BJApplication Completion Method
- BKBacking
- BLBrand/Label
- BMBeam Number
- BNBar-Coded Serial Number
- BOBuyers Color
- BPBuyer's Part Number
- BQBenefit ID
- BRCompensation Type Code
- BSBill Subgroup Code
- BTVolume Type Identification Code
- BUBus Body Serial Number
- BVBeverage Common Code
- BWCompensation Allocation Code
- BXBill Credit Code
- BYConcept Code
- BZCoverage Type
- C1Channel
- C2Connector Type
- C3Classification
- C4Configuration Item Identifier
- C5Insurance Plan Description Characteristics
- C6Asset Type
- C7Asset Category
- C8Fund Sub-Advisor
- C9Dun & Bradstreet Standard Product and Service Code
- CACase
- CBBuyer's Catalog Number
- CCCompatible Cut Number
- CDMotor Vehicle-Line Designator
- CEClass of Contract Code
- CFChassis Serial Number
- CGCommodity Grouping
- CHCountry of Origin Code
- CICommon Language Equipment Identifier (CLEI)
- CJCurrent Procedural Terminology (CPT) Codes
- CKCandidate Oil
- CLColor
- CMNational Retail Federation Color Code
- CNCommodity Name
- COChemical Abstract Service (CAS) Registry Number
- CPCarry-over Part Number
- CQEquipment Code per COPAS standard
- CRContract Number
- CSService code per COPAS standard
- CTContinuation (ID Number Spans Multiple Product ID Data Elements)
- CUCut Number
- CVCustomer Provided Equipment
- CWContract Activity Code
- CXCompletion Number
- CYCustomer Company Registry Number
- CZCountry from which Procured
- D1Underwriting Method of Direct Writer
- D2Medical Information Bureau (MIB) Authorization
- D3Policy Form
- D4Plan Code
- D5Coverage Risk Type
- D6Medical Stop Loss Level Codes
- D7Medical Stop Loss Coverage Codes
- D8Medical Stop Loss Product Line Codes
- DAAutomobile Repair Product Code
- DCInternational Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)
- DDDistributor
- DEDesign Number
- DFDevice Family
- DGDiscount Grouping
- DHTransport4 Commodity Code
- DIDeposit Item Number
- DLDye Lot Number
- DMCommittee for Uniform Security Identification Procedure Number (CUSIP) Number
- DNDie Number
- DODividend Use
- DPDiscontinued Part Number
- DQEvent Type
- DRDrawing Revision Number
- DSGroup ID
- DTDevice Type
- DUJoint Life Type
- DVLocation Code
- DWNonforfeiture Option
- DXInternational Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) - Diagnosis
- DYPremium Rate Type
- DZDiagnosis Code Pointer
- E1Contract Change Authorization Type
- E2Fund Abbreviation
- E3Fund Type
- E4Related Policy Identification
- E5Tax Code
- E6Contract Transfer Reason Code
- EAEAN-99 In-store Coupon Code
- EBFuel Tank Serial Number
- ECEngineering Change Level
- EDEngine Displacement Identification
- EEPremium Use
- EFExhibit Identifier
- EGPurpose of Insurance
- EHSales Presentation ID
- EIExpense Identifier
- EJService Feature ID
- EKSettlement/Payout Option
- ELBuyer's Subline Item Number
- EMEquipment Identification Number
- ENGTIN-13
- EOGTIN-8
- EPBuyer's End Product Number
- EQEquipment Type
- ERJurisdiction Specific Procedure and Supply Codes
- ESEngine Serial Number
- ETDepartment of Defense Enterprise Identifier
- EUSkill Code
- EXExchanged Part, Assembly or Product
- EZShift Worked
- F1Catalog Number
- F2Technical Order Number
- F3Technical Manual Number
- F4Series Identifier
- F5Obligation Authority Number
- F6First Prior Identifier
- F7End-Item Description
- F8Next Higher Used Assembly
- F9Former Publisher
- FAFailed Subassembly Serial Number
- FBForm Number
- FCCoupon Family Code
- FDFund
- FEFeature
- FFFifth Wheel Serial Number
- FGFund Manager
- FHFreddie Mac Affordable Lending Product Code
- FIFinish Number
- FJFannie Mae Affordable Lending Product Code
- FKFreddie Mac Project Condominium Classification Code
- FLFinish Lot Number
- FMFailed Subassembly Model Number
- FNFinal Test Lot Number
- FPFabric Pieces Per Roll
- FQFannie Mae Project Condominium Classification Code
- FRFront Axle, Rear
- FSNational Stock Number
- FTFederal Supply Classification
- FUNational Alcohol Beverage Control Association (NABCA) Product Code
- FVDrug Identification Number (DIN)
- FWNew Microcode
- FXFederal Supply Group
- GAGathering
- GCGrade Code
- GDGrain Direction
- GEGeneric Name Description
- GIGraphics Industry Bar Code (GIBC)
- GKGlider Kit
- GMGeneral Services Administration (GSA) Special Item Number
- GNGrade Name
- GQGroup Qualifier Code
- GRGear Ratio
- GSGeneral Specification Number
- GUVolume Usage Identification Code
- HCHealthcare Common Procedure Coding System (HCPCS) Codes
- HDInternational Harmonized Commodity Code
- HIHIBC (Health Care Industry Bar Code) Supplier Labeling Standard Primary Data Message
- HNHeat Number
- HPHealth Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code
- IAInformation Media Type
- IBInternational Standard Book Number (ISBN)
- ICInterior Color Number
- IDInternational Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) - Procedure
- IEInsurer's Fund Code
- IFInvestment Fund Type
- IGIgnition Key Number
- IICommodity Item Identification
- IMImprint (Trademark Code of Subsidiary)
- INBuyer's Item Number
- IPInternational Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS)
- IQIRS Qualification Code
- IRIngredient
- ISInternational Standard Serial Number (ISSN)
- ITBuyer's Style Number
- IUDepartment of Defense Issuing Agency Code
- IV
- IWInterchangeability Code
- IZBuyer's Size Code
- JAAnniversary
- JBCommission Identifier
- JCCommission Year
- JDContribution Year
- JNJob Number
- JPPackage Type Code
- JSJob Sequence Number
- KAEngineering Data List
- KBData Category Code
- KDReplacement National Stock Number
- KEMilitary Standard
- KFItem Type Number
- KGTime Compliant Technical Order
- KICognizance Symbol
- KJMaterial Control Code
- KKSpecial Material Identification Code
- KLItem Management Code
- KMShelf-Life Code
- KNShelf-Life Action Code
- KPKanban Plan Number
- L1Program Level
- L2Topic Level
- L3Subtopic Level
- L4Life/Annuity Service Features
- L5Line of Authority
- L6Lube, Synthetic
- LALabor Group
- LBLogical Observation Identifier Names and Codes (LOINC) Codes
- LCLaboratory Test Condition Code
- LDSNOMED, Systematized Nomenclature of Medicine
- LGLift Gate Serial Number
- LMLottery Game Number
- LNLottery Pack/Book Number
- LPLife/Annuity Product Code
- LRLease Number
- LSLoad Sequence
- LTLot Number
- LULot Pricing Unit Number
- MAMachine Number
- MBMeasurement Type Code
- MCMortgage Credit Data Order Type
- MDMethod of Delivery Code
- MEMarket Program Code
- MFManufacturer
- MGManufacturer's Part Number
- MHMedication Code
- MIMortgage Insurance Product Code or Number
- MJManual Transmission Serial Number
- MKFront Axle Non Driven Serial Number
- MMMotor Equipment Manufacturing Association (MEMA) Product Type Code
- MNModel Number
- MOMovement Type Code
- MPMortgage Product Code
- MQMortgage Underwriting Type
- MRMaintenance Index Page Reference Number
- MSMilitary Specification (MILSPEC) Number
- MTMajor Product/Material/Machine Type
- MUAuthorized Parts List Number
- MVEquipment Location
- MWEquipment Hierarchical Sequence Identifier
- MXRepair Induction Identifier
- N1National Drug Code in 4-4-2 Format
- N2National Drug Code in 5-3-2 Format
- N3National Drug Code in 5-4-1 Format
- N4National Drug Code in 5-4-2 Format
- N5National Health Related Item Code in 5-5 Format
- N6National Health Related Item Code in 4-6 Format
- NDNational Drug Code (NDC)
- NEYarn Count - English
- NGNational Glass Association (NAGS) Number
- NHNational Health Related Item Code
- NMYarn Count - Metric
- NNNational Item Identification Number
- NRNon-resaleable item (excluding deposit) number
- NUNational Uniform Billing Committee (NUBC) UB92 Codes
- NWNew Replacement Part or Assembly Defective
- NZCombined NCCMA/Bank Service Code
- O9Old Vendor's (Seller's) Item Number
- OEOriginal Equipment Number
- OFOld Common Language Equipment Identifier (CLEI) Code
- OGOld Microcode
- OHOpposite-Hand Part Number
- OIOptical Industry Product Code
- OLOptical Cable Code
- OMOriginal Part Number
- ONCustomer Order Number
- OOOutside Production Operation Sheet Number
- OPObsolete Part Number
- OROffer Number
- OTInternal Number
- OUOriginal Unit of Issue
- P1Petroleum Accountants Society of Canada Operating and Maintenance Code - Goods and Services Tax Not Applicable
- P2Petroleum Accountants Society of Canada Capital Expenditure Code - Goods and Services Tax Not Applicable
- P3Petroleum Accountants Society of Canada Tubular Code
- P4Petroleum Accountants Society of Canada Non-Tubular Code
- P5Material Discharge Number
- P6Pump, Fire
- P7Previous Carrier
- P8Retail Price Look Up Number (PLU)
- P9Ply
- PAPattern Number
- PBPetroleum Accountants Society of Canada Operating and Maintenance Code - Goods and Services Tax Forwarded
- PCPrime Contractor Part Number
- PDPart Number Description
- PEPieces in Roll
- PFPetroleum Accountants Society of Canada Capital Expenditure Code - Goods and Services Tax Forwarded
- PGPackaging Specification Number
- PHProperty and Casualty Service Code
- PIPurchaser's Item Code
- PJProduct Date Code (A code indicating the period during which a product was manufactured.)
- PKPackaging Drawing
- PLPurchaser's Order Line Number
- PMNumber of Positions on Machine
- PNCompany Part Number
- POPurchase Order Number
- PPAir Transportation Association Proprietary Rights Code
- PQProduct ID Attribute Code
- PRProcess Number
- PSPosition
- PTPrint or Drawing
- PUPart Reference Number
- PVAdvertising Package Identification Code
- PWPart Drawing
- PXSecondary Ply
- PYOperator Assigned Property Identification
- PZProduct Change Notice Number
- R1Replacement Subassembly Model Number
- R2Replacement Subassembly Serial Number
- R3Rear Axle, Middle
- R4Rear Axle, Pusher
- R5Rear Axle, Tag
- R6Rear Axle, Extended Tag
- R9Replacement Vendor's (Seller's) Item Number
- RAReturn Code
- RBNational Uniform Billing Committee (NUBC) UB82 Codes
- RCReturnable Container Number
- RDReel Number
- REReefer Serial Number
- RFRepair From Product Code
- RGReference Oil
- RHRadiator Serial Number
- RIRear Axle Front Rear Driven Serial Number
- RJRear Axle Rear Driven Serial Number
- RKRack Number
- RLRate Detail Card
- RMRelated Model Number
- RNRelease Number
- RORoll Number
- RPReplaced Part Number
- RQAutomobile Rental Charge Item Code
- RRReplacement Product Number
- RSSet Number
- RTReel Type
- RURun Number
- RVRepair Tag Number
- RWRelative Value Units
- RXProvisioning Reference Number
- RYRecord Keeping or Model Year
- RZRelated Model Type
- S1Shipper's Item Number
- S2Second Prior Identifier
- S3Phase
- S4Laboratory Sample Identification
- S5State Sample Identification
- S6Previous Sample Identification
- S7Source of Deposit Code
- S8Source of Lead Code
- SASchematic Diagram Reference Number
- SBSubmission Number
- SCSeller's Date Code
- SDSupplier Company Registry Number
- SESection Print Number
- SFSurface Finish
- SGSeat Serial Number
- SHService Requested
- SIStandard Industrial Classification Code
- SJReligious Retail Non-book Item
- SKStock Keeping Unit (SKU)
- SLSeller's Lot Number
- SMNational Retail Federation Size Code
- SNSerial Number
- SOSystem Identifier
- SPSuperseded Purchase Order Number
- SQRoll Sequence Number
- SRSubstitute Product Number
- SSSuperseded Part Number
- STStyle Number
- SUSide Up/Side Down
- SVService Rendered
- SWStock Number
- SXSleeper Box Key Number
- SYSleeper Box Serial Number
- SZVendor Alphanumeric Size Code
- T2Tex
- T3Third Prior Identifier
- TAPipeline Transaction Code
- TBAssociation for Financial Professionals Service Code and Bank Service Code
- TCTelecommunications Circuit ID
- TDTreatment Codes
- TEAssociation for Financial Professionals Service Code
- TFThe Air Cargo Tariff (TACT) Commodity Code
- TGAutomatic Transmission Serial Number
- THTransfer Case Serial Number
- TITrade In Identifier
- TJAuxiliary Transmission Serial Number
- TKTransmission, Auxillary
- TMTelephone Industry Manufacturer Code
- TNRailroad-Owned Unit Train Number
- TPProduct Type Code
- TRTruck Body Serial Number
- TSTransmission Serial Number
- TTType Selvage
- TUTested Material Identification Number
- TVLine of Business
- TWProgram Code
- TXFederal Aviation Administration (FAA) Service Bulletin Number
- TYTelecommunications Industry Service Code
- TZProgram Description Identifier
- U3United Nations Common Coding System (UNCCS)
- U5Broker Price Opinion Service
- U6Real Estate Property Information Service
- U7Department of Defense Unique Item Identifier
- UCProduct Variant
- UFUser-Defined Shipping Container Identifier
- UJU.P.C./EAN Coupon Code (2-5-5)
- UKGTIN-14
- ULU.P.C. Coupon Code (1-5-5-1)
- UMUniversal Vendor Marking, Short Code (UVM; U Line)
- UOEAN.UCC Serial Shipping Container Code (SSCC)
- UPGTIN-12
- UQUnited Nations (UN) Number (Dangerous Goods)
- URUCC/EAN-128 Coupon Extended Code
- USUniform Stock Symbol System Code Number
- UTCompany-Owned Unit Train Number
- UVUniversal Vendor Marking, Long Code (UVM; R,P,M Lines)
- UXUniversal Product Number
- UYDepartment of Defense Unique Item Identifier Type Reference Identifier
- VAVendor's Style Number
- VBVendor's Engineering Change Level Number
- VCVendor's (Seller's) Catalog Number
- VEVendor Color
- VIVary Item Product Number
- VMVehicle Maintenance Reporting Standards
- VNVendor's (Seller's) Item Number
- VOVendor's Order Number
- VPVendor's (Seller's) Part Number
- VSVendor's Supplemental Item Number
- VTVintage
- VUVendor's Basic Unit Number
- VVMotor Vehicle ID Number
- VXVendor's Specification Number
- W1End Item Serial Number
- W2Work Unit Number
- W5Reclamation Process
- W6Woolen Run
- W7Woolen Cut
- WARandom Weight Aggregation Code
- WBCar Class Code
- WCWorld Code
- WDAirline Flight Code
- WEFare Basis Code
- WFService Class Code
- WGStop Over Code
- WJTelecom Service Type
- WKAdvanced Billing Concepts (ABC) Codes
- WLWafer Lot Identifier
- WRYarn Count Worsted
- WSWheel Chair Lift Serial Number
- XAPreferred Part Number
- XCExpendable Container Identification
- XPPreferred National Stock Number
- XQPreferred Manufacturer
- XZContractor Establishment Code
- YMMap Edition Number
- YPPublication Number
- ZBCommercial and Government Entity (CAGE) Code
- ZRService Control Identification
- ZZMutually Defined
Code indicating the type of agreement under which the provider is submitting this claim
Codes (7)- DManaged Dental Care Program
- ECivilian Health and Medical Program of the Uniformed Services (CHAMPUS) "External" Partnership Agreement
- HHealth Maintenance Organization (HMO) Agreement
- ICivilian Health and Medical Program of the Uniformed Services (CHAMPUS) "Internal" Partnership Agreement
- NNo Agreement
- PParticipation Agreement
- YPreferred Provider Organization (PPO) Agreement
