NDC codes

FDA NDC Directory
Product NDC (as listed)0126-0288Labeler and product segments. Claims need a package NDC.
Product NDC at billing width00126-0288Add the package segment from the table below.
Package NDCs as listed with the FDA, and the 11-digit 5-4-2 form used on claims. The highlighted digit is the added leading zero.
Package NDC11-digit (billing)PackageCopy
0126-0288-02001260288021 TUBE in 1 CARTON (0126-0288-02) / 56 g in 1 TUBEMarketed from Jul 15, 2016

How the 11-digit form is made: The labeler segment has 4 digits, so one leading zero is added to it (4-4-2 → 5-4-2). Formatting the NDC does not by itself make it billable — the product, package and quantity must match what was dispensed or administered, and payer rules apply. Conversion rules

Product information

Brand name (proprietary)
PreviDent Very Berry
Generic name (nonproprietary)
sodium fluoride
Active ingredients
Sodium fluoride — 5 mg/g
Dosage form
Gel, Dentifrice
Route
Dental
Product type
Prescription drug
Marketing category
Unapproved drug (other)
Marketing start
Listing expires
Identifiers
Product ID 0126-0288_e16a75ef-1e92-474e-8134-f9f3416a07efSPL ID e16a75ef-1e92-474e-8134-f9f3416a07efSPL set ID 2ecc57ec-cd25-4911-9247-6375569b8abeRxCUI 392038, 630194UNII 8ZYQ1474W7

Billing references

What Med-Code can say about coding this product, and where each statement comes from. Nothing here is inferred from the name alone.

HCPCS codeNo match

No drug-specific HCPCS code in Med-Code's directory for this product. The directory is curated and not complete — check the current CMS HCPCS file before billing.

NDC on a medical claim

N400126028802 followed by a unit qualifier and the quantity

Package 00126-0288-02. Unit qualifiers: F2 (international unit), GR (gram), ME (milligram), ML (milliliter), UN (unit (each)). The qualifier and quantity depend on what was given. About the N4 qualifier

Product label

Label details couldn’t be retrieved right now. Open the label on DailyMed.

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