| Name | Description | Type | Additional information |
|---|---|---|---|
| PrimaryInsurerDetails | PersonalDetails |
None. |
|
| PatientDetails | PatientDetails |
None. |
|
| DentalClaimDetails | DentalClaimInformation |
None. |
|
| ReimbursementDetails | ReimbursementDetails |
None. |
|
| TreatmentDetails | DentalTreatmentDetails |
None. |
|
| AdditionalNotes | string |
None. |