ANTIETAM PEDIATRIC AND ADOLESCENT CARE, LLC
NPI: 1780627810
· HAGERSTOWN, MD 21740
· Pediatric Adolescent Medicine Physician
· NPI assigned 06/14/2006
$131K
Total Medicaid Paid
Provider Details
| Authorized Official | WEAVER, LEON (PARTNER) |
| NPI Enumeration Date | 06/14/2006 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
528 |
$13K |
| 2019 |
550 |
$13K |
| 2020 |
392 |
$11K |
| 2021 |
545 |
$14K |
| 2022 |
694 |
$28K |
| 2023 |
657 |
$22K |
| 2024 |
668 |
$29K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
3,429 |
3,358 |
$84K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
399 |
351 |
$35K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
76 |
62 |
$10K |
| 90686 |
|
52 |
36 |
$989.61 |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
21 |
19 |
$353.01 |
| 96127 |
|
13 |
13 |
$61.23 |
| 1160F |
|
22 |
17 |
$0.00 |
| 1159F |
|
22 |
17 |
$0.00 |