Medicare procedure market data by CPT code & state

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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS

21085 Impression and custom preparation of oral surgical splint CPT · Musculoskeletal procedure

Classification Procedure › Musculoskeletal (CMS RBCS)

First observed 2013 — start of our 12-year window; the code predates it

National scale 1,295 services ▼ 28.8% YoY · 1,084 beneficiaries (CY2024, Medicare FFS)

Medicare paid $659K · $508.69 avg / service, national

CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window

Billing groups

Named groups billing this code

Named-group FFS services

319

Attributable volume · fee-for-service

FFS of Medicare

49%

Payer-mix frame

Services · year over year

Services YoY

-28.8%

FFS enrollment -2.2%

Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.

Estimated all-Medicare volume estimate

FFS + estimated MA

~600 services

319 observed fee-for-service (53%) · ~281 estimated Medicare Advantage.

Scaled from the observed floor by each state’s fee-for-service share (FFS share as of 2024) — scaled estimate — assumes MA utilization mirrors FFS; not an observation. How we scale

Top states — 21085 (CY2024)

CA 267 AZ 229 NJ 213 TX 170 WA 116

Disclosed Medicare fee-for-service services by billing state; open a bar for that state's ranked market.

Billed → allowed → paid

Named-group submitted charges

$627K

Named-group allowed amount

$210K

Named-group Medicare payments

$165K

Avg charge / svc

$1,965

Avg allowed / svc

$657

Avg payment / svc

$518

Totals are named-group (attributable) sums. Allowed is Medicare’s fee-schedule recognized price — what CMS recognizes, before the 80% Medicare pays.

Average charge per group

$850–1,147

$1,147–1,444

$1,444–1,742

$1,742–2,039

$2,039–2,336

$2,336–2,633

$2,633–2,930

$2,930+

$850 9 groups · avg submitted charge / service $3,292

Market analyticsPlatform Methods →

Search a single state to see that market's full analytics — the free tier previews every panel, gated.

Or just look at it: nuclear heart imaging (78452) in Arizona is open as a live example — the full paid view, real data.

View the live example →

Data year: CY2024 CY2023 CY2022 CY2021 CY2020

Physician groups ranked by 21085 services, highest first, CY2024
#	Physician group activate to sort	City activate to sort	St activate to sort	Specialty activate to sort	Providers activate to sort	21085 svcs sorted descending — activate to reverse	Submitted charges activate to sort	Avg charge activate to sort	Medicare $ locked column	Share* activate to sort	Phone
1	NORTHFIELD DENTAL GROUP	WEST ORANGE	NJ	DENTIST	2	157	$298,500	$1,901	premium	73.7%	(973) 736-0111
2	OPREX MEDICAL GROUP PLLC	HOUSTON	TX	OTOLARYNGOLOGY	4	42	$99,792	$2,376	premium	24.7%	2819205558306
3	STEPHEN J HARKINS DDS PC	TUCSON	AZ	DENTIST	3	29	$44,950	$1,550	premium	12.7%	(520) 298-6909
4	CEDARS-SINAI MEDICAL CARE FOUNDATION	LOS ANGELES	CA	PHYSICIAN ASSISTANT	1699	19	$28,500	$1,500	premium	7.1%	(310) 423-0674
5	OROFACIAL AND DENTAL IMPLANT SURGERY ASSOCIATES PA	ORLANDO	FL	ORAL SURGERY	4	16	$36,800	$2,300	premium	20.8%	(407) 351-0575
6	STONY BROOK ORAL AND FACIAL SURGERY PC	STONY BROOK	NY	ORAL SURGERY	3	15	$12,750	$850	premium	100.0%	(631) 675-9601
7	UNIVERSITY MEDICAL ASSOCIATES OF THE MEDICAL UNIVERSITY OF SOUTH CAROL	CHARLESTON	SC	PHYSICIAN ASSISTANT	1692	14	$43,830	$3,131	premium	100.0%	(843) 792-1414
8	HEATON EAR NOSE AND THROAT ASSOCIATES OF EAST TEXAS P A	TYLER	TX	OTOLARYNGOLOGY	8	14	$18,900	$1,350	premium	8.2%	(903) 592-5601
9	DIGNITY HEALTH MEDICAL FOUNDATION	FOLSOM	CA	DIAGNOSTIC RADIOLOGY	1197	13	$42,793	$3,292	premium	4.9%	(916) 983-7476

*Share of the state's disclosed Medicare-FFS services for the primary code, counted once per clinician. "St" is the state the volume was billed from: a group appears in each state where its clinicians bill Medicare, with that state's volume and share ("City" is the group's registered location). Group figures sum clinicians affiliated with exactly one group; clinicians in several groups are listed in each group's drill-down but not volume-attributed to any single group, so shares reflect attributable volume. See Methods.

Comparing against an all-payer estimate?

These are exact counts from Medicare fee-for-service claims — roughly a third to half of most procedure markets, depending on payer mix. Modeled all-payer databases project the remainder statistically; we publish the audited floor and label it as such. Same market, different denominator. How the numbers reconcile →