| Name | Value |
|---|---|
| FORM FIELD REFERENCE | IB 837 TRANSMISSION |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-ORTHO TX MTHS COUNT |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | I $$FT^IBCEF(IBXIEN)'=7 K IBXDATA |
| FORMAT CODE DESCRIPTION | Ortho Treatment Months count for Dental Claim |