Claims Terms

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Across
  1. 2. reason code for approval or denial of the service line
  2. 4. amount of copayment paid by member for service
  3. 7. amount excluded from the submitted amount for the service line
  4. 9. amount submitted for reimbursement for the service line
  5. 11. description of the procedure being submitted for payment
  6. 15. date of service
Down
  1. 1. surface code if required for the service
  2. 3. auto-adjudication status for the claim
  3. 5. payable CDT code
  4. 6. CDT code submitted for approval
  5. 8. amount payable for reimbursement for the service line
  6. 10. tooth number if required for the service
  7. 12. how many services or materials were provided
  8. 13. manual adjudication status for the claim
  9. 14. amount of deductible paid by member for service