|
{ |
|
"</s_DEN_AMIField>": 57648, |
|
"</s_DEN_AutoAccidentState>": 57690, |
|
"</s_DEN_BillProvAddr1>": 57536, |
|
"</s_DEN_BillProvCity>": 57734, |
|
"</s_DEN_BillProvFedIdCode>": 57534, |
|
"</s_DEN_BillProvFullName>": 57544, |
|
"</s_DEN_BillProvLicenseId>": 57765, |
|
"</s_DEN_BillProvNPI>": 57741, |
|
"</s_DEN_BillProvOrgName>": 57556, |
|
"</s_DEN_BillProvOtherId>": 57748, |
|
"</s_DEN_BillProvPhone>": 57739, |
|
"</s_DEN_BillProvPostCode>": 57561, |
|
"</s_DEN_BillProvState>": 57634, |
|
"</s_DEN_DateAppliancePlaced>": 57733, |
|
"</s_DEN_DateOfAccident>": 57653, |
|
"</s_DEN_DatePriorPlacement>": 57766, |
|
"</s_DEN_DentalForm>": 57645, |
|
"</s_DEN_DiagCode>": 57651, |
|
"</s_DEN_DiagCodeQual>": 57550, |
|
"</s_DEN_DiagDesc>": 57595, |
|
"</s_DEN_Encloseure>": 57564, |
|
"</s_DEN_FacProvAddr1>": 57576, |
|
"</s_DEN_FacProvCity>": 57547, |
|
"</s_DEN_FacProvFullName>": 57669, |
|
"</s_DEN_FacProvHospital>": 57749, |
|
"</s_DEN_FacProvLicenseId>": 57580, |
|
"</s_DEN_FacProvNPI>": 57599, |
|
"</s_DEN_FacProvOffice>": 57694, |
|
"</s_DEN_FacProvOrgName>": 57668, |
|
"</s_DEN_FacProvOther>": 57607, |
|
"</s_DEN_FacProvOtherId>": 57610, |
|
"</s_DEN_FacProvPhone>": 57750, |
|
"</s_DEN_FacProvPostCode>": 57529, |
|
"</s_DEN_FacProvSignDate>": 57709, |
|
"</s_DEN_FacProvSignOnFile>": 57587, |
|
"</s_DEN_FacProvSpecialtyCode>": 57532, |
|
"</s_DEN_FacProvState>": 57725, |
|
"</s_DEN_FacProvTreatmentECF>": 57633, |
|
"</s_DEN_FedTaxClass>": 57715, |
|
"</s_DEN_IsThereSecInsN>": 57656, |
|
"</s_DEN_IsThereSecInsY>": 57751, |
|
"</s_DEN_MissingTooth>": 57612, |
|
"</s_DEN_MnthsOfTrmntRemain>": 57554, |
|
"</s_DEN_NEANum>": 57616, |
|
"</s_DEN_NoOfDraftImages>": 57685, |
|
"</s_DEN_NoOfModels>": 57695, |
|
"</s_DEN_NoOfRadiographs>": 57558, |
|
"</s_DEN_OrthodonticsN>": 57760, |
|
"</s_DEN_OrthodonticsY>": 57737, |
|
"</s_DEN_OtherCharges>": 57548, |
|
"</s_DEN_PatAcctNo>": 57673, |
|
"</s_DEN_PatAddr1>": 57569, |
|
"</s_DEN_PatCity>": 57677, |
|
"</s_DEN_PatConditionAuto>": 57541, |
|
"</s_DEN_PatConditionEmp>": 57644, |
|
"</s_DEN_PatConditionOther>": 57638, |
|
"</s_DEN_PatDOB>": 57588, |
|
"</s_DEN_PatFullName>": 57680, |
|
"</s_DEN_PatPostCode>": 57671, |
|
"</s_DEN_PatRelShipDep>": 57553, |
|
"</s_DEN_PatRelShipOther>": 57565, |
|
"</s_DEN_PatRelShipSelf>": 57687, |
|
"</s_DEN_PatRelShipSpouse>": 57756, |
|
"</s_DEN_PatSexF>": 57574, |
|
"</s_DEN_PatSexM>": 57683, |
|
"</s_DEN_PatSignDate>": 57563, |
|
"</s_DEN_PatSignonFile>": 57581, |
|
"</s_DEN_PatState>": 57764, |
|
"</s_DEN_PatStudentStatusCodeFT>": 57583, |
|
"</s_DEN_PatStudentStatusCodePT>": 57549, |
|
"</s_DEN_PayerAddr1>": 57642, |
|
"</s_DEN_PayerCity>": 57679, |
|
"</s_DEN_PayerOrgName>": 57571, |
|
"</s_DEN_PayerPostCode>": 57625, |
|
"</s_DEN_PayerState>": 57528, |
|
"</s_DEN_PlaceOfTreatment>": 57650, |
|
"</s_DEN_PreAuthNum>": 57531, |
|
"</s_DEN_PriInsAddr1>": 57546, |
|
"</s_DEN_PriInsCity>": 57704, |
|
"</s_DEN_PriInsDOB>": 57606, |
|
"</s_DEN_PriInsEmpName>": 57582, |
|
"</s_DEN_PriInsFullName>": 57681, |
|
"</s_DEN_PriInsIDNumber>": 57684, |
|
"</s_DEN_PriInsPolGrpNumber>": 57630, |
|
"</s_DEN_PriInsPostCode>": 57527, |
|
"</s_DEN_PriInsSexF>": 57609, |
|
"</s_DEN_PriInsSexM>": 57667, |
|
"</s_DEN_PriInsState>": 57720, |
|
"</s_DEN_PriSignDate>": 57716, |
|
"</s_DEN_PriSignonFile>": 57672, |
|
"</s_DEN_Remarks>": 57710, |
|
"</s_DEN_RplProsthesisN>": 57557, |
|
"</s_DEN_RplProsthesisY>": 57713, |
|
"</s_DEN_SSNField>": 57624, |
|
"</s_DEN_SecInsAddr1>": 57689, |
|
"</s_DEN_SecInsCity>": 57728, |
|
"</s_DEN_SecInsDOB>": 57753, |
|
"</s_DEN_SecInsFullName>": 57757, |
|
"</s_DEN_SecInsIDNumber>": 57623, |
|
"</s_DEN_SecInsOrgName>": 57696, |
|
"</s_DEN_SecInsPolGrpNumber>": 57700, |
|
"</s_DEN_SecInsPostCode>": 57601, |
|
"</s_DEN_SecInsSexF>": 57579, |
|
"</s_DEN_SecInsSexM>": 57611, |
|
"</s_DEN_SecInsState>": 57643, |
|
"</s_DEN_SecRelShipDep>": 57738, |
|
"</s_DEN_SecRelShipOther>": 57735, |
|
"</s_DEN_SecRelShipSelf>": 57567, |
|
"</s_DEN_SecRelShipSpouse>": 57537, |
|
"</s_DEN_TotalCharges>": 57692, |
|
"</s_DEN_TransTypeEPSDT>": 57637, |
|
"</s_DEN_TransTypeReqforPreAuth>": 57711, |
|
"</s_DEN_TransTypeStmtOfServ>": 57575, |
|
"</s_Row_10>": 57752, |
|
"</s_Row_11>": 57535, |
|
"</s_Row_12>": 57526, |
|
"</s_Row_1>": 57670, |
|
"</s_Row_2>": 57652, |
|
"</s_Row_3>": 57723, |
|
"</s_Row_4>": 57545, |
|
"</s_Row_5>": 57530, |
|
"</s_Row_6>": 57552, |
|
"</s_Row_7>": 57771, |
|
"</s_Row_8>": 57631, |
|
"</s_Row_9>": 57664, |
|
"<one>": 57776, |
|
"<s_DEN_AMIField>": 57731, |
|
"<s_DEN_AutoAccidentState>": 57570, |
|
"<s_DEN_BillProvAddr1>": 57555, |
|
"<s_DEN_BillProvCity>": 57626, |
|
"<s_DEN_BillProvFedIdCode>": 57525, |
|
"<s_DEN_BillProvFullName>": 57617, |
|
"<s_DEN_BillProvLicenseId>": 57568, |
|
"<s_DEN_BillProvNPI>": 57714, |
|
"<s_DEN_BillProvOrgName>": 57726, |
|
"<s_DEN_BillProvOtherId>": 57682, |
|
"<s_DEN_BillProvPhone>": 57746, |
|
"<s_DEN_BillProvPostCode>": 57675, |
|
"<s_DEN_BillProvState>": 57659, |
|
"<s_DEN_DateAppliancePlaced>": 57661, |
|
"<s_DEN_DateOfAccident>": 57635, |
|
"<s_DEN_DatePriorPlacement>": 57641, |
|
"<s_DEN_DentalForm>": 57755, |
|
"<s_DEN_DiagCode>": 57699, |
|
"<s_DEN_DiagCodeQual>": 57758, |
|
"<s_DEN_DiagDesc>": 57562, |
|
"<s_DEN_Encloseure>": 57702, |
|
"<s_DEN_FacProvAddr1>": 57706, |
|
"<s_DEN_FacProvCity>": 57619, |
|
"<s_DEN_FacProvFullName>": 57560, |
|
"<s_DEN_FacProvHospital>": 57621, |
|
"<s_DEN_FacProvLicenseId>": 57658, |
|
"<s_DEN_FacProvNPI>": 57646, |
|
"<s_DEN_FacProvOffice>": 57774, |
|
"<s_DEN_FacProvOrgName>": 57747, |
|
"<s_DEN_FacProvOther>": 57628, |
|
"<s_DEN_FacProvOtherId>": 57573, |
|
"<s_DEN_FacProvPhone>": 57540, |
|
"<s_DEN_FacProvPostCode>": 57686, |
|
"<s_DEN_FacProvSignDate>": 57608, |
|
"<s_DEN_FacProvSignOnFile>": 57719, |
|
"<s_DEN_FacProvSpecialtyCode>": 57632, |
|
"<s_DEN_FacProvState>": 57759, |
|
"<s_DEN_FacProvTreatmentECF>": 57724, |
|
"<s_DEN_FedTaxClass>": 57729, |
|
"<s_DEN_IsThereSecInsN>": 57769, |
|
"<s_DEN_IsThereSecInsY>": 57743, |
|
"<s_DEN_MissingTooth>": 57754, |
|
"<s_DEN_MnthsOfTrmntRemain>": 57559, |
|
"<s_DEN_NEANum>": 57688, |
|
"<s_DEN_NoOfDraftImages>": 57629, |
|
"<s_DEN_NoOfModels>": 57701, |
|
"<s_DEN_NoOfRadiographs>": 57620, |
|
"<s_DEN_OrthodonticsN>": 57717, |
|
"<s_DEN_OrthodonticsY>": 57584, |
|
"<s_DEN_OtherCharges>": 57697, |
|
"<s_DEN_PatAcctNo>": 57597, |
|
"<s_DEN_PatAddr1>": 57698, |
|
"<s_DEN_PatCity>": 57718, |
|
"<s_DEN_PatConditionAuto>": 57742, |
|
"<s_DEN_PatConditionEmp>": 57761, |
|
"<s_DEN_PatConditionOther>": 57763, |
|
"<s_DEN_PatDOB>": 57744, |
|
"<s_DEN_PatFullName>": 57772, |
|
"<s_DEN_PatPostCode>": 57773, |
|
"<s_DEN_PatRelShipDep>": 57589, |
|
"<s_DEN_PatRelShipOther>": 57592, |
|
"<s_DEN_PatRelShipSelf>": 57605, |
|
"<s_DEN_PatRelShipSpouse>": 57660, |
|
"<s_DEN_PatSexF>": 57603, |
|
"<s_DEN_PatSexM>": 57712, |
|
"<s_DEN_PatSignDate>": 57708, |
|
"<s_DEN_PatSignonFile>": 57613, |
|
"<s_DEN_PatState>": 57762, |
|
"<s_DEN_PatStudentStatusCodeFT>": 57636, |
|
"<s_DEN_PatStudentStatusCodePT>": 57736, |
|
"<s_DEN_PayerAddr1>": 57602, |
|
"<s_DEN_PayerCity>": 57640, |
|
"<s_DEN_PayerOrgName>": 57732, |
|
"<s_DEN_PayerPostCode>": 57655, |
|
"<s_DEN_PayerState>": 57662, |
|
"<s_DEN_PlaceOfTreatment>": 57705, |
|
"<s_DEN_PreAuthNum>": 57722, |
|
"<s_DEN_PriInsAddr1>": 57657, |
|
"<s_DEN_PriInsCity>": 57627, |
|
"<s_DEN_PriInsDOB>": 57542, |
|
"<s_DEN_PriInsEmpName>": 57622, |
|
"<s_DEN_PriInsFullName>": 57572, |
|
"<s_DEN_PriInsIDNumber>": 57604, |
|
"<s_DEN_PriInsPolGrpNumber>": 57551, |
|
"<s_DEN_PriInsPostCode>": 57538, |
|
"<s_DEN_PriInsSexF>": 57768, |
|
"<s_DEN_PriInsSexM>": 57767, |
|
"<s_DEN_PriInsState>": 57740, |
|
"<s_DEN_PriSignDate>": 57727, |
|
"<s_DEN_PriSignonFile>": 57586, |
|
"<s_DEN_Remarks>": 57590, |
|
"<s_DEN_RplProsthesisN>": 57596, |
|
"<s_DEN_RplProsthesisY>": 57649, |
|
"<s_DEN_SSNField>": 57721, |
|
"<s_DEN_SecInsAddr1>": 57647, |
|
"<s_DEN_SecInsCity>": 57674, |
|
"<s_DEN_SecInsDOB>": 57600, |
|
"<s_DEN_SecInsFullName>": 57639, |
|
"<s_DEN_SecInsIDNumber>": 57770, |
|
"<s_DEN_SecInsOrgName>": 57745, |
|
"<s_DEN_SecInsPolGrpNumber>": 57566, |
|
"<s_DEN_SecInsPostCode>": 57618, |
|
"<s_DEN_SecInsSexF>": 57693, |
|
"<s_DEN_SecInsSexM>": 57593, |
|
"<s_DEN_SecInsState>": 57578, |
|
"<s_DEN_SecRelShipDep>": 57539, |
|
"<s_DEN_SecRelShipOther>": 57666, |
|
"<s_DEN_SecRelShipSelf>": 57676, |
|
"<s_DEN_SecRelShipSpouse>": 57598, |
|
"<s_DEN_TotalCharges>": 57543, |
|
"<s_DEN_TransTypeEPSDT>": 57591, |
|
"<s_DEN_TransTypeReqforPreAuth>": 57614, |
|
"<s_DEN_TransTypeStmtOfServ>": 57707, |
|
"<s_Row_10>": 57594, |
|
"<s_Row_11>": 57615, |
|
"<s_Row_12>": 57577, |
|
"<s_Row_1>": 57691, |
|
"<s_Row_2>": 57663, |
|
"<s_Row_3>": 57730, |
|
"<s_Row_4>": 57585, |
|
"<s_Row_5>": 57703, |
|
"<s_Row_6>": 57654, |
|
"<s_Row_7>": 57678, |
|
"<s_Row_8>": 57533, |
|
"<s_Row_9>": 57665, |
|
"<s_iitcdip>": 57523, |
|
"<s_synthdog>": 57524, |
|
"<sep/>": 57522, |
|
"[BLANK]": 57775 |
|
} |
|
|