Anticavity Rinse
NDC Package 55910-030-77

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

Package Information

Anticavity (sodium fluoride) rinses is adults and children 6 years of age and older: use once a day after brushing your teeth with toothpasteremove cappour 10 milliliters (10 mL mark on inside of cap); do not fill above 10 mL markvigorously swish 10 milliliters of rinse between your teeth for 1 minute then spit outdo not swallow the rinsedo not eat or drink for 30 minutes after rinsinginstruct children under 12 years of age in good rinsing habits (to minimize swallowing)supervise children as necessary until capable of using without supervisionchildren under 6 year of age: consult a dentist or doctor. This formulation utilizes a rinse delivery system. Marketed by Old East Main Co., this product is identified by NDC 55910-030 and is authorized under FDA application M021.

Identification & Billing

NDC Package Code
55910-030-77
Package Description
500 mL in 1 BOTTLE, PLASTIC
Product Code
55910-030
11-Digit Billing Format
55910003077
RxNorm Crosswalk

Clinical Specifications

Proprietary Name
Anticavity
Non-Proprietary Name
Sodium Fluoride
Substance Name
Sodium Fluoride
Dosage Form
Rinse - A liquid used to cleanse by flushing.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
SODIUM FLUORIDE .2 mg/mL
Usage Information
Adults and children 6 years of age and older: use once a day after brushing your teeth with toothpasteremove cappour 10 milliliters (10 mL mark on inside of cap); do not fill above 10 mL markvigorously swish 10 milliliters of rinse between your teeth for 1 minute then spit outdo not swallow the rinsedo not eat or drink for 30 minutes after rinsinginstruct children under 12 years of age in good rinsing habits (to minimize swallowing)supervise children as necessary until capable of using without supervisionchildren under 6 year of age: consult a dentist or doctor

Regulatory & Marketing

Labeler Name
Old East Main Co.
Product Type
Human Otc Drug
FDA Application #
M021
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
02-24-2015
Listing Expiration
12-31-2027
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.

Other Available Packages

The following commercial packages are registered under the same Product NDC (55910-030). Click a package code to view its specific billing and regulatory data.

55910-030-44
532 mL in 1 BOTTLE, PLASTIC

* 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 55910-030-77 identifies a specific commercial package of 500 ml in 1 bottle, plastic of Anticavity, a human over the counter drug labeled by Old East Main Co.. This rinse is formulated for oral use and contains 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 Old East Main Co. on February 24, 2015. The current certification is valid through December 31, 2027.

How is this Old East Main Co. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 55910003077. 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 (5-3-2)
55910-030-77
11-Digit CMS (5-4-2)
55910-0030-77

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