External Required External Code Tooth Code Number when Source 10 - Report the tooth identifier(s) when DC032 is DC 48 11/8/12 Source varchar[20] or DC032 = 100% A2 Tooth within the given range Letter 10 - Identification D2000 thru Numbering Text D2999 Required when External DC032 External Code Code Report the standard quadrant identifier from indicates Dental Source 10 - Dental DC 49 11/8/12 Source char[2] the External Code Source here. Provides procedures 100% B Quadrant Dental Quadrant 10 - further detail on procedure(s). of 3 or Quadrants Numeric more teeth External Required Code External Code Report the tooth surface(s) that this service Tooth Tooth Service when DC 50 11/8/12 Source Source 10 - varchar[10] relates to. Provides further detail on 100% A2 Surface Identification DC047 is 10 - Surfaces procedure. populated Text Report the last name of the subscriber. Used to validate Unique Member ID. Last name should exclude all punctuation, including hyphens and apostrophes, and be Name Last Last name of DC 51 Last 10/15/10 Text varchar[60] reported in case. Name should be All 100% B Subscriber Subscriber Name contracted where punctuation is removed, do not report spaces. EXAMPLE: O'Brien becomes OBRIEN; Carlton-Smythe becomes CARLTONSMYTHE Report the first name of the subscriber here. Used to validate Unique Member ID. Exclude all punctuation, including hyphens Name First name of DC 52 First 10/15/10 Text varchar[25] and apostrophes. Name should be All 100% B Subscriber Subscriber Name contracted where punctuation is removed, do not report spaces. EXAMPLE: becomes ANNEMARIE Name Middle Middle initial of Report the Subscriber's middle initial here. DC 53 Middle 10/15/10 Text char[1] All 2% C Subscriber Subscriber Used to validate Unique Member ID. Initial
DC 48 Tooth 11/8/12 External Code Source 10 - Text External Code Source 10 - Tooth Numbering varchar[20] Number or Letter Identification Report the tooth identifier(s) when DC032 is within the given range Required when DC032 = D2000 thru D2999 100% A2 DC 49 Dental Quadrant 11/8/12 External Code Source 10 - Numeric External Code Source 10 - Dental Quadrants char[2] Dental Quadrant Report the standard quadrant identifier from the External Code Source here. Provides further detail on procedure(s). Required when DC032 indicates procedures of 3 or more teeth 100% B DC 50 Tooth Surface 11/8/12 External Code Source 10 - Text External Code Source 10 - Surfaces varchar[10] Tooth Service Identification Report the tooth surface(s) that this service relates to. Provides further detail on procedure. Required when DC047 is populated 100% A2 DC 51 Last Name 10/15/10 Text Name Last Subscriber varchar[60] Last name of Subscriber Report the last name of the subscriber. Used to validate Unique Member ID. Last name should exclude all punctuation, including hyphens and apostrophes, and be reported in case. Name should be contracted where punctuation is removed, do not report spaces. EXAMPLE: O'Brien becomes OBRIEN; Carlton-Smythe becomes CARLTONSMYTHE All 100% B DC 52 First Name 10/15/10 Text Name Subscriber varchar[25] First name of Subscriber Report the first name of the subscriber here. Used to validate Unique Member ID. Exclude all punctuation, including hyphens and apostrophes. Name should be contracted where punctuation is removed, do not report spaces. EXAMPLE: becomes ANNEMARIE All 100% B DC 53 Middle Initial 10/15/10 Text Name Middle Subscriber char[1] Middle initial of Subscriber Report the Subscriber's middle initial here. Used to validate Unique Member ID. All 2% C