Oral

Datasets

An oral claim is a dental bill (ADA Dental Claim Form) from a dentist, dental group or dental clinic, coded in CDT and located on teeth, surfaces and areas of the mouth. It is built like a professional claim: adjudication happens on the lines, and the claim row carries totals. CARIN Blue Button STU 2.1.0 profiles it twice: the financial profile with amounts for Patient Access, and its parent Basis profile without amounts for Provider Access and Payer-to-Payer. You deliver one pair of files.

Dataset	CARIN BB STU 2.1.0 target profile
`claims_oral`	C4BB ExplanationOfBenefit Oral, served without amounts as Oral Basis
`claims_oral_lines`	`ExplanationOfBenefit.item` of the same profile

Both files carry every column from Explanation of Benefit. This page lists what the oral profile adds and where it tightens a shared rule.

claims_oral

One row per dental claim.

Claim

Column	Required	Format / values	Example
`claim_received_date`	Recommended	date the payer received the claim	`2026-03-18`
`service_facility_npi`	If not the billing provider's place	10 digits; key from `organizations`; where the service was rendered when it is neither the billing provider nor the patient's home	`9999999993`
`medical_record_number`	If available	the provider's medical record number on the claim	`MR-88213`
`patient_account_number`	If available	the provider's patient account number on the claim	`ACC-530118`
`orthodontics_months`	If orthodontics	decimal; months of orthodontic treatment, from the ADA claim form. Send `1` when your system only holds a yes/no orthodontics flag	`24`
`prosthesis_replacement`	If a prosthesis	`true` when the prosthesis replaces an existing one, `false` when it is the first	`true`
`missing_tooth_numbers`	If a prosthesis	teeth already missing, `;`-separated tooth numbers ADAUniversalNumberingSystem	`18;19;30`

billing_provider_npi may resolve to a Practitioner or an Organization: a solo dentist bills under their own NPI, a group under the practice's.
CARIN carries the orthodontics indicator as a quantity, not a flag, so orthodontics_months is a number. prosthesis_replacement is the yes/no from the ADA form's "replacement of prosthesis" item.
The ADA tooth numbering and CDT procedure codes are licensed. Tooth numbers and surfaces are small enough to be expanded here; the CDT value set is linked to the IG.

Care team

One column per role, bound to C4BBClaimProfessionalAndNonClinicianCareTeamRole, the same set as professional claims.

Column	Required	Format / values	Example
`rendering_provider_npi`	Recommended	10 digits; key from `practitioners`; the treating dentist	`9999999991`
`rendering_provider_taxonomy`	If available	NUCC taxonomy code the dentist billed under Healthcare Provider Taxonomy	`122300000X`
`referring_provider_npi`	If available	10 digits; key from `practitioners`
`supervising_provider_npi`	If available	10 digits; key from `practitioners`
`primary_provider_npi`	If available	10 digits; key from `practitioners`
`purchased_service_provider_npi`	If available	10 digits; key from `practitioners` or `organizations`; a dental laboratory, for example

Rendering, referring, supervising and primary must resolve to a Practitioner. Purchased service may be either.

Diagnoses

Optional on dental claims, unlike every other type. When sent, they follow the professional shape: aligned ;-separated lists with principal first.

Column	Required	Format / values	Example
`diagnosis_codes`	If available	ICD-10-CM codes, `;`-separated CDCICD910CMDiagnosisCodes	`K02.52`
`diagnosis_types`	If `diagnosis_codes`	`principal`, `secondary`, aligned with `diagnosis_codes` C4BBClaimProfessionalAndNonClinicianDiagnosisType	`principal`
`diagnosis_code_system`	If not ICD-10-CM	`http://hl7.org/fhir/sid/icd-9-cm` for services before October 2015 (ICD-10-CM assumed when empty)

Adjudication

Oral is the one claim type that carries the benefit payment status at both levels and requires the rendering network status.

Column	Required	Format / values	Example
`benefit_payment_status`	Yes	`innetwork`, `outofnetwork`, `other`; how the claim as a whole was paid against the member's dental benefit C4BBPayerBenefitPaymentStatus	`innetwork`
`rendering_network_status`	Yes	`innetwork`, `outofnetwork`; whether the treating dentist had a contract with the plan on the date of service C4BBPayerProviderNetworkStatus	`innetwork`
`billing_network_status`	Recommended	`innetwork`, `outofnetwork`; the same for the billing provider	`innetwork`

Each line also carries its own benefit_payment_status. The claim-level value summarizes the claim; where the lines differ, send other on the claim and the real value on each line.
payment_date from the shared columns is must-support here. Send it whenever the claim was paid.

Amounts

The shared amount columns on the claim row become the claim totals, which are mandatory: at least one must be filled. The oral profile has no claim-level adjudication amounts; line amounts are mandatory, see below.

Set by Payerbox

Element	Value
`type`	`oral`
`use`	`claim`
`meta.profile`	the Oral canonical with version `2.1.0`
`identifier.type`	`uc`
`insurance.focal`	`true` on the coverage from `coverage_id`
`careTeam.sequence`, `supportingInfo.sequence`, `diagnosis.sequence`, `item.informationSequence`	numbered from the columns and list positions

claims_oral_lines

One row per dental procedure. Each line names the procedure, where it was done, and which tooth, surfaces or area of the mouth it applies to.

Column	Required	Format / values	Example
`service_code`	Yes	CDT procedure code ADADentalProcedureCode	`D2392`
`service_code_system`	No	`http://www.ada.org/cdt` is the only system here (assumed when empty)
`modifier_codes`	If billed	CPT or HCPCS modifiers, `;`-separated AMACPTCMSHCPCSModifiers
`service_date_start`	Yes	date the procedure was performed	`2026-03-12`
`service_date_end`	If a period	date a multi-visit procedure ended; blank otherwise
`place_of_service`	Yes	two-digit CMS place-of-service code CMSPlaceofServiceCodes	`11`
`tooth_number`	If a tooth	the tooth the procedure was done on: `1` to `32`, or `A` to `T` for primary teeth ADAUniversalNumberingSystem	`19`
`oral_cavity_area`	If an area	the area of the mouth when the procedure is not on one tooth: `00` whole mouth, `01` upper arch, `02` lower arch, `10` `20` `30` `40` quadrants OralBodySite	`02`
`tooth_surfaces`	If surfaces	surfaces treated, `;`-separated: `M`, `O`, `I`, `D`, `B`, `F`, `L` C4BBSurfaceCodes	`M;O`
`additional_tooth_numbers`	If several teeth	further teeth or areas the same line covers, `;`-separated, same values as `tooth_number` and `oral_cavity_area`	`18;20`
`quantity`	If available	decimal; units billed on the line	`1`
`diagnosis_sequences`	If available	positions in the claim's `diagnosis_codes` this line was billed against, `;`-separated	`1`
`benefit_payment_status`	Yes	`innetwork`, `outofnetwork`, `other`; how this line was paid C4BBPayerBenefitPaymentStatus	`innetwork`
`allowed_units`	If adjudicated	decimal; units the payer allowed	`1`
`adjustment_reason_code`	If reduced or denied	one CARC or RARC code explaining the noncovered amount X12 CARC and RARC	`96`
`adjustment_reason_system`	If RARC	`https://x12.org/codes/remittance-advice-remark-codes` (CARC, `https://x12.org/codes/claim-adjustment-reason-codes`, assumed when empty)
amount columns	Yes, at least one	line-level adjudication, one column per category

service_code is mandatory on every line and is a CDT code, five characters starting with D. No other system is accepted; a line coded in CPT belongs on a professional claim.
tooth_number and oral_cavity_area are one FHIR element, the body site. Send one or the other: a filling names a tooth, a denture or a cleaning names an arch or the whole mouth. Payerbox chooses the code system from which column is filled.
tooth_surfaces belongs to the tooth in tooth_number. Surfaces on a line with no tooth are rejected.
additional_tooth_numbers covers procedures that span several teeth, such as a bitewing radiograph. The first tooth goes in tooth_number; the rest here. Each becomes an additional body-site entry linked to this line, which is how CARIN requires them to be carried.
benefit_payment_status and at least one amount are mandatory on every line. adjustment_reason_code is a single code, as on professional claims.

These resources are served by Patient Access with amounts, and by Provider Access and Payer-to-Payer without them.