Acclean Anti-cavity Sensitivity Relief Paste, Dentifrice
NDC Package 0404-0174-04

View Billable Units, 11-Digit Conversion Format, and RxNorm mappings
Table of Contents
    1. Package Information
    2. Frequently Asked Questions

Package Information

Acclean Anti-cavity Sensitivity Relief (potassium nitrate, sodium fluoride) pastes is acclean Prescription Strength Anti-Cavity Toothpaste for Sensitivity Relief is indicated for use as part of a professional program for the prevention and control of dental caries. This formulation utilizes a paste, dentifrice delivery system. Marketed by Henry Schein, Inc., this product is identified by NDC 0404-0174.

Identification & Billing

NDC Package Code
0404-0174-04
Package Description
1 TUBE in 1 CARTON / 113.4 g in 1 TUBE
Product Code
0404-0174
11-Digit Billing Format
00404017404
RxNorm Crosswalk
  • RxCUI: 637365 - potassium nitrate 5 % / sodium fluoride 1.1 % Toothpaste
  • RxCUI: 637365 - potassium nitrate 0.05 MG/MG / sodium fluoride 0.011 MG/MG Toothpaste
  • RxCUI: 637365 - K+ nitrate 0.05 MG/MG / Sodium Fluoride 0.011 MG/MG Toothpaste
  • RxCUI: 637365 - Pot nitrate 0.05 MG/MG / Sodium Fluoride 0.011 MG/MG Toothpaste
  • RxCUI: 637365 - potassium nitrate 5 % / sodium fluoride 1.1 % Gel Toothpaste

Clinical Specifications

Proprietary Name
Acclean Anti-cavity Sensitivity Relief
Non-Proprietary Name
Potassium Nitrate, Sodium Fluoride
Substance Name
Potassium Nitrate; Sodium Fluoride
Dosage Form
Paste, Dentifrice - A paste formulation intended to clean and/or polish the teeth, and which may contain certain additional agents.
Administration Route
Topical - Administration to a particular spot on the outer surface of the body. The E2B term TRANSMAMMARY is a subset of the term TOPICAL.
Active Ingredient(s)
Usage Information
Acclean Prescription Strength Anti-Cavity Toothpaste for Sensitivity Relief is indicated for use as part of a professional program for the prevention and control of dental caries.

Regulatory & Marketing

Labeler Name
Henry Schein, Inc.
Product Type
Human Prescription Drug
Marketing Category
UNAPPROVED DRUG OTHER - An unapproved drug product in a marketing category that is not reflected on a particular list.
Start Marketing Date
01-30-2025
Listing Expiration
12-31-2026
Exclude Flag
N
Sample Package
No

Hierarchy Structure

Code Lineage

The NDC Directory contains ONLY information on final marketed drugs submitted to FDA electronically by labelers. A labeler might be a manufacturer, re-packager or re-labeler. The product information included in the NDC directory does not indicate that FDA has verified the information provided by the product labeler. Assigned NDC numbers are not in any way an indication of FDA approval of the product.

* Please review the full disclaimer at the bottom of this page.

Frequently Asked Questions

What is the distribution configuration for this product package?

The code 0404-0174-04 identifies a specific commercial package of 1 tube in 1 carton / 113.4 g in 1 tube of Acclean Anti-cavity Sensitivity Relief, a human prescription drug labeled by Henry Schein, Inc.. This paste, dentifrice is formulated for topical use and contains potassium nitrate; sodium fluoride as the active substance.

Is this product currently listed with the FDA?

Yes, this product is active and verified within the NDC Directory. It was introduced to the market by Henry Schein, Inc. on January 30, 2025. The current certification is valid through December 31, 2026.

How is this Henry Schein, Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 00404017404. The table below illustrates the segment conversion from the 10-digit labeler code to the 11-digit provider format.

11-Digit Code Conversion

Billing payers usually require a 5-4-2 segment configuration. Below is the conversion from the 10-digit package format to the 11-digit billing format:

10-Digit Format (4-4-2)
0404-0174-04
11-Digit CMS (5-4-2)
00404-0174-04

Note: The zero is added to the Labeler segment to maintain the 5-4-2 structure.