> ## Documentation Index
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# 837D file anatomy
> Annotated 837D with the loop and segment map, the dental-specific segments (SV3, TOO, oral cavity, ortho fields), the fields that cause most rejections, and the 837P crossover differences.
This page maps the loops and segments in the **837D** dental claim transaction (X12N 837 Health Care Claim: Dental, implementation guide `005010X224A2`). It is intended for operators investigating a rejection and for engineers parsing claim files. For a conceptual walkthrough, see [The 837D](/concepts/payments/understanding-837d).
## The loop hierarchy
X12 organizes data into nested **loops**. The 837D shares its skeleton with the other 837 variants; the dental content lives in the claim and service-line loops:
| Loop | Contains |
| ------------- | ----------------------------------------------------------------------------------------------------------------------------------------------- |
| **1000A** | Submitter |
| **1000B** | Receiver |
| **2000A** | Billing provider hierarchical level |
| **2010AA** | **Billing provider**, usually the professional entity: name, NPI, Tax ID, and address |
| 2010AB | Pay-to address, if different |
| **2000B** | Subscriber hierarchical level |
| **2010BA** | **Subscriber**, member ID, name, DOB |
| **2010BB** | **Payer** |
| **2000C** | Patient hierarchical level (only when the patient is not the subscriber; routine in dentistry, where the patient is very often a covered child) |
| **2010CA** | Patient |
| **2300** | **Claim**: total charge, frequency code, predetermination indicator, preauthorization number, attachment reference, orthodontic fields |
| 2310 | Claim-level providers: referring dentist, **rendering dentist** (the individual, Type 1 NPI), service facility location |
| **2320/2330** | Coordination-of-benefits loops: the other payer and, on a secondary claim, the primary's adjudication |
| **2400** | **Service line**, one per CDT procedure: charge, date, tooth and oral-cavity detail |
## Annotated example
An 837D fragment with each segment explained. Element positions inside the dental segments are simplified; your payer's companion guide is authoritative for the exact layout.1
```text theme={null}
ISA*00* *00* *ZZ*SUBMITTERID *ZZ*PAYERID *260813*1200*^*00501*000000001*0*P*:~
GS*HC*SUBMITTERID*PAYERID*20260813*1200*1*X*005010X224A2~
ST*837*0001*005010X224A2~
BHT*0019*00*REF123*20260813*1200*CH~
NM1*41*2*BLUEBIRD DENTAL*****46*SUBMITTERID~
NM1*40*2*SAMPLE DENTAL PAYER*****46*PAYERID~
HL*1**20*1~
NM1*85*2*MAYA OKAFOR DDS PC*****XX*1234567890~
N3*100 MAIN ST~
N4*COLUMBUS*OH*43215~
REF*EI*880000000~
PRV*BI*PXC*122300000X~
HL*2*1*22*0~
SBR*P*18*******CI~
NM1*IL*1*CHEN*MARGARET****MI*ABC123456789~
DMG*D8*19710415*F~
NM1*PR*2*SAMPLE DENTAL PAYER*****PI*PAYERID~
CLM*PATACCT001*452.00***11:B:1*Y*A*Y*Y~
NM1*82*1*OKAFOR*MAYA****XX*1987654321~
LX*1~
SV3*AD:D1110*142.00~
DTP*472*D8*20260801~
LX*2~
SV3*AD:D2391*310.00****1~
TOO*JP*30*O~
DTP*472*D8*20260801~
SE*25*0001~
GE*1*1~
IEA*1*000000001~
```
### Segment by segment
| Segment | Meaning |
| ------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
| `ISA` | Interchange envelope: sender, receiver, date, control number, delimiters |
| `GS` | Functional group. `HC` = health care claim. `005010X224A2` identifies the **837D** implementation guide |
| `ST` | Transaction set start |
| `BHT` | Beginning of hierarchical transaction. `CH` = chargeable; an actual claim rather than a report |
| `NM1*41` | **Submitter**, who transmitted the file; often your clearinghouse configuration, and where a multi-PC group misroutes claims |
| `NM1*40` | **Receiver** |
| `HL*1**20*1` | Hierarchical level: `20` = information source (billing provider) |
| `NM1*85` | **Billing provider.** `2` means organization and `XX` qualifies the NPI. Use the enrolled legal name, which may differ from the brand |
| `N3` / `N4` | Address |
| `REF*EI` | **Employer ID**, the Tax ID |
| `PRV*BI*PXC*...` | Billing provider **taxonomy**. `PXC` qualifies a taxonomy code; here `122300000X`, dentist. See [Taxonomy codes](/reference/edi/taxonomy-codes) |
| `HL*2*1*22*0` | `22` = subscriber level |
| `SBR*P*18*...*CI` | Subscriber: `P` = primary, `18` = self, `CI` = commercial insurance |
| `NM1*IL` | **Subscriber.** `MI` qualifies the member ID |
| `DMG*D8*...` | Demographics: date format `D8` = CCYYMMDD |
| `NM1*PR` | **Payer** |
| `CLM` | **Claim**: patient account number, total charge, then the composite `11:B:1` carrying the place-of-treatment code and the **claim frequency code** (`1` original) |
| `NM1*82` | **Rendering dentist**, the individual's Type 1 NPI; must be credentialed and linked to the group contract |
| `LX` | Service line counter |
| `SV3*AD:D1110*142.00` | **Dental service line.** `SV3` is the dental line segment; the 837P uses `SV1`. `AD` qualifies a **CDT** code. This example reports D1110, adult prophylaxis, which does not need a tooth number |
| `SV3*AD:D2391*310.00...` | Second line: D2391, a one-surface posterior composite |
| `TOO*JP*30*O` | **Tooth information**, which does not appear on a medical claim: tooth `30`, occlusal surface `O` |
| `DTP*472*D8*...` | Service date. `472` = service |
| `SE` / `GE` / `IEA` | Transaction, group, and interchange trailers with segment counts |
## The dental-specific content
What separates an 837D from the other 837 variants, beyond the code set:1
| Element | What it carries | Why it exists |
| --------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------- |
| **CDT service lines** (`SV3`, `AD` qualifier) | "D" plus four digits per procedure | CDT is the HIPAA-designated dental code set; see [CDT & the 837D](/reference/edi/cdt-and-837d) |
| **Tooth information** (`TOO`) | Tooth number and surface codes | Lets the payer enforce per-tooth history: a crown's replacement interval, a missing tooth clause, prior restorations on the same surface |
| **Oral cavity designation** | Quadrant, arch, or area at the service line | Quadrant-based procedures; scaling and root planing is adjudicated per quadrant |
| **Orthodontic fields** | Banding date and months of treatment remaining | Ortho's installment-payment model runs on these; continuation claims without them pend |
| **Predetermination indicator** | Flags the transaction as a predetermination request rather than a chargeable claim | The payer returns an estimate for planned work instead of a payment; see [Get predeterminations](/guides/billing/get-predeterminations) |
| **COB loops** | The other payer's identity and, on secondary claims, the primary's adjudication | Dental COB is routine; child patients under two parents' plans, ordered by the birthday rule |
| **Attachment reference** | A claim-level pointer to documentation sent separately; an NEA number in the remarks, or the attachment control segment (`PWK`) where the companion guide specifies it | Many payers require radiographs or charting before adjudicating crowns, SRP, or implants; see [Dental attachments](/reference/edi/dental-attachments) |
| **Diagnosis codes** | ICD-10-CM, **situational** | Required by some payers and many Medicaid programs, not the organizing principle it is in medical billing |
The implementation guide defines where these fields belong, while each payer's companion guide states which situational fields it requires.1
## Common rejection fields
| Field | Location | Failure |
| ------------------------------- | ------------------------ | --------------------------------------------------------------------------------------------------------------------------------- |
| **Billing provider legal name** | `NM1*85` | The brand name ("Bluebird Dental") instead of the PC's legal name; doesn't match the payer's records / the CP 575 |
| **Billing provider NPI** | `NM1*85`, `XX` qualifier | Wrong entity's Type 2 in a multi-PC group |
| **Tax ID** | `REF*EI` | Doesn't match enrollment; post-acquisition, the seller's TIN still configured |
| **Taxonomy** | `PRV*BI*PXC` | Doesn't match the enrolled taxonomy |
| **Rendering dentist NPI** | `NM1*82` | Not credentialed or not linked to the group contract |
| **Subscriber ID** | `NM1*IL`, `MI` qualifier | Transposed digits; plan entered under the wrong parent |
| **Date of birth** | `DMG` | Doesn't match the payer's record |
| **Tooth / surface data** | `TOO` and service line | Missing tooth number where the code requires one; surface count inconsistent with the code (a one-surface code with two surfaces) |
| **Oral cavity designation** | Service line | Missing quadrant on a quadrant-based procedure |
| **Preauthorization number** | Claim level | Medicaid or DHMO preauthorization obtained but never entered in the structured field |
| **Attachment reference** | Claim remarks / `PWK` | Documentation uploaded but the claim never points to it |
| **COB order** | `SBR` / 2320 loops | Primary claim sent to the secondary plan |
| **Claim frequency code** | `CLM05` composite | `1` original, `7` replacement, `8` void; resubmitting an adjudicated claim as `1` denies as duplicate |
| **Service date** | `DTP*472` | Before the rendering dentist's effective date |
Many of these failures originate in enrollment or system configuration rather than the clinical claim. See [Set up EDI, ERA, and EFT](/guides/enrollment/set-up-edi-era-eft).
## 837P, the crossover format
The 837P (`005010X222A1`) is the professional medical claim. A dental group may use it for medically billable oral surgery, sleep appliances, trauma, or other services submitted to a patient's medical plan. Important differences include:
| Element | 837D | 837P |
| -------------------- | -------------------------------------- | -------------------------------------------------------- |
| Implementation guide | `005010X224A2` | `005010X222A1` |
| Paper analogue | ADA Dental Claim Form | CMS-1500 |
| Procedure codes | **CDT** (`AD` qualifier) | CPT/HCPCS (`HC` qualifier) |
| Service line segment | **`SV3`** | `SV1` |
| Tooth-level data | `TOO` segment, oral cavity designation | None |
| Diagnosis codes | Situational | **Required**; ICD-10-CM drives adjudication |
| Place of service | Place-of-treatment code | POS code with facility/non-facility payment consequences |
Medical billing requires a different code set, documentation standard, and enrollment. It is not simply a conversion of the dental claim fields. See [Bill medical plans for dental work](/guides/billing/bill-medical-for-dental-work) and [Place of service codes](/reference/edi/place-of-service-codes).
## Corrected claims
| Frequency code (`CLM05-3`) | Meaning |
| -------------------------- | -------------------------------- |
| `1` | Original |
| `7` | **Replacement** of a prior claim |
| `8` | **Void** / cancel a prior claim |
A `7` or `8` must reference the original claim number, typically in `REF*F8` (payer claim control number); you'll find that number in the [835](/reference/edi/835-anatomy)'s `CLP07`.
Unless the payer instructs otherwise, do not resubmit an adjudicated claim with frequency code `1`. It may deny as a duplicate (CARC 18) and consume the correction window.
## Sources
1. X12N 837D implementation guide 005010X224A2; segment-level requirements and dental-content placement per payer companion guides: UnitedHealthcare, [837D companion guide, 005010X224A2 (PDF)](https://www.uhcprovider.com/content/dam/provider/docs/public/resources/edi/EDI-837D-Companion-Guide-Dental-005010X224A2.pdf); Delta Dental, [837 companion guide (PDF)](https://www1.deltadentalins.com/content/dam/ddins/en/pdf/dentists/companion-guide-837.pdf); Stedi, [Differences between 837P, 837D, and 837I claims](https://www.stedi.com/blog/differences-between-837p-professional-837d-dental-and-837i-institutional-claims).