Bon Scent Sparkling Tooth Wash
NDC Package 72869-010-02

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

Package Information

This product is EXCLUDED from the official NDC directory because the listing data was inactivated by the FDA.

Bon Scent Sparkling Tooth Wash is directions:- Put 1 tablet into your mouth and wash your gums, teeth, and tongue using your tongue and lips.-Lastly rinse several times with water. Marketed by Lucella Co.,ltd, this product is identified by NDC 72869-010 and is authorized under FDA application part355.

Identification & Billing

NDC Package Code
72869-010-02
Package Description
30 BLISTER PACK in 1 POUCH / 853 mg in 1 BLISTER PACK (72869-010-01)
Product Code
72869-010
11-Digit Billing Format
72869001002

Clinical Specifications

Proprietary Name
Bon Scent Sparkling Tooth Wash
Dosage Form
-
Usage Information
Directions:- Put 1 tablet into your mouth and wash your gums, teeth, and tongue using your tongue and lips.-Lastly rinse several times with water.

Regulatory & Marketing

Labeler Name
Lucella Co.,ltd
FDA Application #
part355
Marketing Category
OTC MONOGRAPH FINAL - A product marketed pursuant to a final Over-the-Counter (OTC) Drug Monograph.
Start Marketing Date
01-02-2019
Listing Expiration
12-31-2020
Exclude Flag
I
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 72869-010-02 identifies a specific commercial package of 30 blister pack in 1 pouch / 853 mg in 1 blister pack (72869-010-01) of Bon Scent Sparkling Tooth Wash, labeled by Lucella Co.,ltd. This is formulated for use and contains as the active substance.

Is this product currently listed with the FDA?

This product code is currently listed as inactive or excluded from the primary directory. It was introduced to the market by Lucella Co.,ltd on January 02, 2019. The current certification is valid through December 31, 2020.

How is this Lucella Co.,ltd product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 72869001002. 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)
72869-010-02
11-Digit CMS (5-4-2)
72869-0010-02

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