Most practice owners run their numbers in isolation. They know their own production, their own overhead, and their own case acceptance, but they don't know how those numbers compare to other practices at their stage.
Without that comparison, you can't tell whether you're winning or losing. A 60 percent acceptance rate sounds fine until you find out top performers are at 75. A 65 percent overhead sounds tight until you discover practices at the same revenue level are running at 55.
Below are the benchmarks I work with across my Breakthrough partners. These are real numbers from real practices in 2026 to 2027. Pull your own numbers and compare.
New Patient Starts Per Month
Total new starts is the most basic measure of practice growth. The number to know varies by practice size and market, but here's a working frame:
- Solo practice ($1.5M to $3M): 25 to 50 starts per month
- Mid-market ($3M to $7M): 50 to 100 starts per month
- Larger ($7M to $15M): 100 to 200 starts per month
- Multi-location group ($15M+): 200+ starts per month, with significant variation by site count
Top 1 percent practices in each tier sit at the high end of these ranges or above. If you're at the low end, you have either a marketing problem or a conversion problem. Diagnose which one before you spend more on either.
Case Acceptance Rate
- Average: 55%
- Strong: 65%
- Top 1%: 75% or higher
If you're below 65, you have meaningful upside in your consult system, regardless of what you're spending on marketing. Treatment coordinator training, consult flow rebuild, and same-day start systems are the levers.
Same-Day Start Rate
- Average: 30% to 40% of accepted cases start same-day
- Strong: 50%
- Top 1%: 65% or higher
Same-day starts protect cases from cooling. The lever is operational: open chair time, financial agreements signed in-room, and a clear yes-to-bracket workflow.
Production Per Provider Hour
- Average: $400 to $600
- Strong: $700 to $900
- Top 1%: $1,000+
This metric tells you how efficiently your clinical schedule runs. If you're below $500, the issue is usually template design (gaps, low-yield appointment types, undersold consults) rather than actual capacity.
Cost Per Started Case (CPS)
Total marketing spend divided by total new starts. The single most useful number for evaluating marketing ROI.
- Average: $400 to $700 per started case
- Strong: $250 to $400
- Top 1%: Below $200
Cost per started case below $200 is rare and usually requires both strong marketing efficiency and high case acceptance. If yours is above $700, it's almost always a conversion problem masquerading as a marketing problem.
Lifetime Value Per Patient (LTV)
Average revenue per patient across the full lifecycle of treatment. Includes initial treatment fee, retainers, and any additional services.
- Standard practices: $5,000 to $6,500
- Premium-positioned practices: $7,000 to $9,000
- Top 1% (typically multi-service or high-end): $10,000+
LTV matters for two reasons. First, it sets the ceiling on what you can spend to acquire a patient. Second, it tells you whether your fee structure is supporting a sustainable business model.
Overhead Percentage
- Healthy: 60% to 65% of collections
- Strong: 55% to 60%
- Top 1%: 50% to 55%
Healthy overhead leaves enough margin for the owner to take a real income, invest in growth, and weather a slow quarter. Above 70 percent and you're working harder for less. The fastest fixes usually live in supply costs, scheduling efficiency, and software bloat.
Collections Ratio
- Healthy: 95%+
- Strong: 97%+
- Top 1%: 99%+
Collections below 92 percent usually means insurance claim aging, patient balance issues, or financial agreement breakdown. This is one of the fastest sources of additional cash because the production is already done.
Team-to-Revenue Ratios
- Total payroll as % of collections: Healthy 25% to 30%
- Voluntary turnover: Below 10% annually for top performers; 15% to 25% is industry average
- Time to full productivity for new hires: 60 to 90 days for strong onboarding programs; 6+ months for weak ones
Marketing Spend as Percentage of Collections
- Maintenance mode: 4% to 6%
- Standard growth mode: 6% to 8%
- Aggressive growth mode: 8% to 12%
If you're spending below 4 percent and your starts are flat, the budget is the problem. If you're spending above 12 percent and starts are flat, the funnel is the problem. Both are fixable.
How to Use These Benchmarks
Step one is to pull your own numbers and compare. Step two is to find the two or three metrics where you're significantly below benchmark. Step three is to focus there.
Don't try to fix everything at once. The practices that compound improve one or two metrics at a time, lock in the gains, and move to the next pair. The practices that try to fix ten things simultaneously usually finish the year having fixed none of them.
Where to Start
If your case acceptance is below 65, start there. It's the highest-impact metric in most practices.
If overhead is above 70, start there. The cash flow improvement is fast and frees up budget to invest in everything else.
If both are healthy and starts are still flat, marketing is your lever. Audit your funnel before you increase spend.
The benchmarks above are real, but they're not the whole story. The practices that win year over year are not always the ones with the best individual numbers. They're the ones with the most consistent operating discipline, the strongest teams, and the clearest sense of where they're going.
Frequently Asked Questions
How often should I benchmark my practice?
Quarterly is ideal. Most owners do it annually and miss the chance to course-correct in the moment.
What if my practice is in a rural market?
The benchmarks shift somewhat. Cost per started case can be lower in rural markets. Lifetime value can be higher because of less competition. Overhead can run higher because of fixed costs spread across less revenue. Adjust accordingly.
Are these benchmarks the same for multi-location groups?
Most apply at the location level. Group-level numbers blend stronger and weaker locations. For real diagnosis, look location by location.
What if I'm in a specialty market like adult Invisalign-only?
Specialty practices have their own benchmark profile. The principles are the same. The exact numbers shift.
See How Your Practice Stacks Up
See How Your Practice Stacks Up