Over-the-counter drug · OTC MONOGRAPH DRUG

Anticavity Rinse (Sodium fluoride) NDC 53942-004

Sodium fluoride .2 mg/mL · Mouthwash · Oral · Demoulas Super Markets, Inc

NDC codes

FDA NDC Directory
Product NDC (as listed)53942-004Labeler and product segments. Claims need a package NDC.
Product NDC at billing width53942-0004Add 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
53942-004-4453942000444532 mL in 1 BOTTLE, PLASTIC (53942-004-44)Marketed from May 8, 2013

How the 11-digit form is made: The product segment has 3 digits, so one leading zero is added to it (5-3-2 → 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)
Anticavity Rinse
Generic name (nonproprietary)
sodium fluoride
Active ingredients
Sodium fluoride — .2 mg/mL
Dosage form
Mouthwash
Route
Oral
Labeler
Demoulas Super Markets, IncNDC labeler code 53942
Product type
Over-the-counter drug
Marketing category
OTC monograph drugApplication M 021
Marketing start
Listing expires
Identifiers
Product ID 53942-004_49ee4e01-a61b-d198-e063-6394a90a7d4dSPL ID 49ee4e01-a61b-d198-e063-6394a90a7d4dSPL set ID 6391ca2e-10e8-429d-a873-238a515f9c60RxCUI 240698UNII 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 HCPCS code in Med-Code's directory. Oral products like this are usually dispensed by a pharmacy and billed by NDC.

NDC on a medical claim

N453942000444 followed by a unit qualifier and the quantity

Package 53942-0004-44. 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

Current FDA label (SPL), effective .

Indications (excerpt from the label)

Use aids in the prevention of dental cavities

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)

About NDC 53942-004

What is NDC 53942-004?
53942-004 is the product NDC for Anticavity Rinse (sodium fluoride), Sodium fluoride .2 mg/mL mouthwash, listed with the FDA by Demoulas Super Markets, Inc. It has 1 package NDC, shown above in 10- and 11-digit form.
What drug is associated with this NDC?
Anticavity Rinse (Sodium Fluoride).
What is the active ingredient?
Sodium fluoride.
Who is the labeler?
Demoulas Super Markets, Inc, NDC labeler code 53942. The labeler is the company responsible for the label; it may be the manufacturer, a repackager or a distributor.
What other NDCs exist for Anticavity Rinse?
9 other product NDCs are listed under this name. See all Anticavity Rinse NDCs.
Is there a related HCPCS / J-code?
Not in Med-Code's curated HCPCS directory. See Billing references above.

Other finished products listed under the same name: strengths, forms and labelers.

Other Anticavity Rinse NDCs
ProductStrengthForm · routeLabelerProduct NDCPackage NDCs (11-digit)
Anticavity Rinsesodium fluorideSodium fluoride .5 mg/mLMouthwashOralRite Aid Corporation11822-400411822-4004-04
Anticavity Rinsesodium fluorideSodium fluoride .2 mg/mLMouthwashOralValu Merchandisers Company63941-90463941-0904-77
Anticavity Rinsesodium fluorideSodium fluoride .2 mg/mLMouthwashOralMeijer, Inc.79481-020179481-0201-01
Anticavity Rinsesodium fluorideSodium fluoride .2 mg/mLMouthwashOralAmazon.com Services LLC72288-00472288-0004-44
Anticavity Rinsesodium fluorideSodium fluoride .2 mg/mLMouthwashOralFamily Dollar Stores, Inc55319-00455319-0004-44
Anticavity Rinsesodium fluorideSodium fluoride .2 mg/mLMouthwashOralRetail Business Services, LLC72476-20472476-0204-44
Anticavity Rinsesodium fluorideSodium fluoride .2 mg/mLMouthwashOralH E B37808-80837808-0808-44
Anticavity Rinsesodium fluorideSodium fluoride .2 mg/mLMouthwashOralWalmart Inc.49035-00449035-0004-44
Anticavity Rinsesodium fluorideSodium fluoride .2 mg/mLMouthwashOralMeijer, Inc.41250-00441250-0004-44

Other NDCs under M 021

Products listed under the same FDA application: other strengths and forms, and repackagers who relabel the same product.

FDA NDC Directory listings under M 021
ProductStrengthForm · routeLabelerProduct NDC
Auraglow Whiteningsodium fluorideSodium fluoride 2.3 mg/gPaste, DentifriceDentalAuraglow LLC81740-003
Crayola ANTICAVITY STRAWBERRY FLAVORsodium fluorideSodium fluoride .243 g/100gPaste, DentifriceDentalAshtel Studios, Inc.70108-080
Made by Dentists For Kids Eyeball Juice (Watermelon)sodium fluorideSodium fluoride 1.5 mg/gPasteDentalMADE BY DENTISTS INC75065-030
White Glo Advantage Anticavity Professional Whiteningsodium monofluorophosphateSodium monofluorophosphate 7.6 mg/gPasteTopicalWHITE GLO USA INC73656-027
AutoBrush Mintsodium fluorideSodium fluoride .243 g/100mLLiquidOralLander Enterprises, LLC82913-011
Hello Unicorn Splashsodium fluorideSodium fluoride .02 g/100mLMouthwashDentalAccupac LLC44038-0687
Crest 3D White Stain Eraser Icy Clean Mintsodium fluorideSodium fluoride 1.5 mg/gPaste, DentifriceOralThe Procter & Gamble Manufacturing Company69423-773
White Glo Professional Choice Twin Packsodium fluoride—KitWHITE GLO USA INC73656-024
Therabreath Healthy Gumsstannous fluorideStannous fluoride .454 g/100gPaste, DentifriceOralChurch & Dwight Co., Inc.10237-271
Crest 3D White Vibrant Mintsodium fluorideSodium fluoride 1.5 mg/gPaste, DentifriceOralThe Procter & Gamble Manufacturing Company69423-774
Complete Protectionstannous fluorideStannous fluoride .15 g/100gPaste, DentifriceDental, OralTarget11673-366
Anticavitysodium fluorideSodium fluoride .1 mg/mLRinseOralH E B37808-119
Listerine Total Care Alcohol Free Anticavity Fluoride Mouthwash Fresh Mintsodium fluorideSodium fluoride .1 mg/mLMouthwashOralKenvue Brands LLC69968-0924
White Glo Advantage Anticavity Fluoride Purplesodium monofluorophosphateSodium monofluorophosphate 7.6 mg/gPasteTopicalWHITE GLO USA INC73656-026
Hismilesodium fluorideSodium fluoride .243 g/100gGelDentalHISMILE PTY LTD83013-321
Delta Comfort Plus Amenitysodium monofluorophosphate—KitBuzz Products Inc.69491-043
Hismilebanana flavor sodium fluoride anticavity toothpasteSodium fluoride 2.4 mg/gGelDentalHismile Pty Ltd83013-319
TP OW Stainfighter Clean Mintsodium fluorideSodium fluoride 1.1 mg/gPaste, DentifriceDentalColgate-Palmolive Company35000-999
Sodium FluorideSodium fluoride 2.43 mg/gPaste, DentifriceDentalSafco Dental Supply LLC67239-0226
Delta Travel Kit Comfort plussodium monofluorophosphate—KitBuzz Products Inc.69491-039

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