D-109 NDC 58264-0115

NDC codes

FDA NDC Directory

Product NDC (as listed)58264-0115Labeler and product segments. Claims need a package NDC.

Product NDC at billing width58264-0115Add 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 NDC	11-digit (billing)	Package	Copy
58264-0115-1	58264011501	29.57 mL in 1 BOTTLE, GLASS (58264-0115-1)Marketed from Jan 1, 1990

How the 11-digit form is made: The package segment has 1 digit, so one leading zero is added to it (5-4-1 → 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): D-109
Generic name (nonproprietary): atropa belladonna, virola sebifera resin, silicon dioxide, calcium fluoride, sodium borate, gold, baptisia tinctoria root, mercuric cyanide, calomel, and cornus rugosa whole
Active ingredients: Atropa belladonna — 6 [hp_X]/mLVirola sebifera resin — 4 [hp_X]/mLSilicon dioxide — 8 [hp_X]/mLCalcium fluoride — 8 [hp_X]/mLSodium borate — 4 [hp_X]/mLGold — 8 [hp_X]/mLBaptisia tinctoria root — 4 [hp_X]/mLMercuric cyanide — 8 [hp_X]/mLCalomel — 8 [hp_X]/mLCornus rugosa whole — 9 [hp_X]/mL
Dosage form: Solution
Route: Sublingual
Labeler: DNA Labs, Inc.
Product type: Over-the-counter drug
Marketing category: Unapproved homeopathic
Marketing start: Jan 1, 1990
Listing expires: Dec 31, 2026
Other FDA classes: Allergens (Chemical structure)Cell-mediated Immunity (Physiologic effect)Increased Histamine Release (Physiologic effect)
Identifiers: Product ID 58264-0115_2b9ef9ce-f829-5195-e063-6294a90a28c2SPL ID 2b9ef9ce-f829-5195-e063-6294a90a28c2SPL set ID 7758341d-e0be-487a-ba47-8847551231e1UNII WQZ3G9PF0H, GHJ5XX5SGS, ETJ7Z6XBU4, O3B55K4YKI, 91MBZ8H3QO, 79Y1949PYO, 5EF0HWI5WU, RWG7BD1032, J2D46N657D, 7N444M3926
Pharmacologic class: Standardized Chemical Allergen

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. Sublingual products like this are usually dispensed by a pharmacy and billed by NDC.

NDC on a medical claim

N458264011501 followed by a unit qualifier and the quantity

Package 58264-0115-01. 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

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