Who This Checklist Is For
If you run a dental group with more than one location and you built next year’s marketing plan by taking last year’s number and adding ten percent, this checklist is for you.
The right dental practice marketing budget by DSO size isn’t a single number you can copy off a conference slide. It moves as you grow, and the thing that changes most isn’t the percentage. It’s what the money buys. A 3-location group and a 28-location group can both spend 4% of collections and be doing completely different jobs with it.
Here’s the short version you can take to your next ops meeting:
Dental marketing budgets commonly run 3% to 5% of collections for mature locations, with de novo and newly acquired offices carrying 8% to 12% during their ramp. As a DSO grows past roughly 10 locations, spending shifts away from per-office advertising and toward central infrastructure: call handling, CRM, brand, and reporting.
Use the sections below that match your current size. Check the boxes honestly. There’s a scoring framework at the bottom that tells you whether you have a budget or a spreadsheet full of hope.
What Should a DSO Actually Spend at Each Stage?
A quick caveat before the table. Percent-of-collections is the most overused number in dental marketing, and I say that as someone who uses it constantly. It’s a sanity check, not a plan. A group with three locations in a saturated metro and a group with three locations across rural counties will land in wildly different places and both can be right.
That said, you need a starting line. Here’s the planning range we use with dental clients, along with what actually changes at each stage.
| DSO size | Common planning range (% of collections) | Where most of the money goes | The mistake at this stage | Who runs it |
|---|---|---|---|---|
| 1-3 locations | 4-7% mature, 8-12% for de novo or newly acquired | Google Ads, local SEO, Google Business Profile, website, phone coverage | Spreading a small budget across six channels instead of winning two | Owner or office manager plus an outside agency |
| 4-10 locations | 4-6% blended, with heavier spend on the weakest offices | Paid search per market, centralized intake, CRM, reactivation, review velocity | Averaging the budget evenly across locations regardless of capacity | First full-time marketing hire plus an agency |
| 11-30 locations | 3-5% blended, plus a separate de novo or acquisition ramp line | Brand, call center, attribution, service-line campaigns, doctor recruiting | Counting leads instead of counting booked, kept, and produced | Marketing director plus specialists or agency partners |
| 30+ locations | 3-4% blended, with a defended central budget | Brand equity, data infrastructure, regional media, retention programs | Cutting central spend during a soft quarter and paying for it 9 months later | VP of marketing plus internal team plus vendors |
One more number worth internalizing: your cost per new patient should be evaluated against the production that patient generates, not against some benchmark. A general-dentistry new patient and an implant case new patient are not the same purchase. In our experience, groups that budget by service-line margin instead of by office headcount make better decisions and argue less.
Checklist: 1-3 Locations
At this size, the whole game is proving which channel actually produces kept appointments before you scale anything. You do not have enough budget to be wrong in five places at once.
- [ ] You know your monthly collections per location, written down, not estimated. Why it matters: every budget decision below is a percentage of this number. Verify: pull the last 12 months from your PMS, not from memory.
- [ ] You have picked two channels to fund properly instead of six channels to fund badly. Why it matters: a thin budget split six ways loses to a focused one every time. Verify: your top two line items should account for at least 70% of the total.
- [ ] Your Google Business Profile for each location has current hours, real photos of the office, and active review generation. Why it matters: for most dental searches, the map pack gets clicked before anything else does. Verify: search your primary service plus your city on a phone, logged out, and see if you appear in the top three.
- [ ] Someone answers the phone during business hours, every time, and you have listened to at least ten recorded calls this quarter. Why it matters: the most expensive line on your budget is the ad spend that produces a call nobody answers. Verify: check your missed-call rate in your phone system.
- [ ] You have a de novo or acquisition ramp budget that is separate from your mature-office budget. Why it matters: a new office needs roughly double the spend for the first 6 to 12 months and blending it hides both numbers. Verify: two line items, not one.
- [ ] Any before-and-after photos or results claims in your ads have been reviewed against your state dental board’s advertising rules. Why it matters: state boards regulate how practices advertise clinical results, and the rules vary. Verify: ask your compliance counsel, not your agency, and get the answer in writing.
Checklist: 4-10 Locations
This is where most DSO marketing budgets break. You’ve outgrown the owner-runs-it model but you haven’t yet built anything centralized. Budget gets allocated by fairness instead of by opportunity, and the offices that need the most help get the same money as the ones with a three-week wait.
- [ ] Budget is allocated by chair capacity and market opportunity, not split evenly. Why it matters: spending money to fill a schedule that’s already full produces nothing. Verify: look at your per-location spend next to per-location open chair time. If they don’t correlate inversely, fix it.
- [ ] You have a single intake path, whether that’s a central team or a shared answering standard. Why it matters: eight front desks converting at eight different rates makes channel performance impossible to read. Verify: pull booking rate by location for the same campaign. A spread wider than 20 points is an intake problem, not a marketing problem.
- [ ] Your CRM or patient communication platform is funded as its own line item. Why it matters: reactivation and recall are the cheapest new production in the building and they need software plus somebody who owns it. Verify: name the person. If you can’t, it isn’t owned.
- [ ] You have tagged every patient who hasn’t been in for 18 months and run at least one reactivation campaign against that list this year. Why it matters: those patients have already chosen you once and cost a fraction of a cold lead to bring back. Verify: run the report, count the list, check the campaign send date.
- [ ] You track cost per booked appointment, not cost per lead. Why it matters: lead counts flatter agencies and tell you nothing about the schedule. Verify: your monthly report should show spend, calls, booked, and kept as four separate columns.
- [ ] You’ve killed at least one channel in the last year. Why it matters: if you never cut anything, you aren’t measuring anything. Verify: name the channel and the date.
Checklist: 11-30 Locations and Beyond
Past ten locations, the budget conversation changes character. You’re no longer buying patients office by office. You’re buying a system that produces patients, plus a brand that makes each new acquisition cheaper to integrate than the last one.
11-30 locations
- [ ] Your budget separates central infrastructure from local demand generation. Why it matters: attribution, CRM, brand, and call center are fixed costs that scale; ad spend is variable and market-specific. Blending them makes every cut decision worse. Verify: two sections in the budget doc with their own totals.
- [ ] You budget by service line for your highest-margin production. Why it matters: implants, ortho, and full-arch cases justify a different acquisition cost than hygiene. Verify: you can state your target acquisition cost for at least three service lines.
- [ ] Newly acquired offices get a 6-month ramp budget on day one of the LOI, not after the first soft month. Why it matters: the transition window is when patient attrition happens, and it’s cheaper to hold a patient than to win them back. Verify: the ramp line exists in the deal model.
- [ ] Your reporting connects marketing spend to production, not just to appointments. Why it matters: at this size your board or PE partner will ask, and appointment counts won’t survive the question. Verify: one dashboard, spend to production, by location and by service line.
30+ locations
- [ ] Central brand spend is protected from quarterly cuts. Why it matters: brand search volume takes months to build and the damage from a two-quarter pause shows up long after the quarter you saved. Verify: it’s written into the budget policy, not just understood.
- [ ] You measure branded search volume as a leading indicator. Why it matters: it’s the cleanest signal that your brand investment is compounding and it moves before revenue does. Verify: pull 24 months of branded impressions from Search Console and look at the trend line.
- [ ] You have a retention budget, not just an acquisition budget. Why it matters: at this scale, a one-point improvement in recall compliance across 30 locations outproduces most new campaigns you could launch. Verify: a named line item with a named owner.
- [ ] Doctor and hygienist recruiting marketing is funded separately from patient marketing. Why it matters: an empty operatory from a staffing gap costs exactly what an empty operatory from a marketing gap costs, and the two budgets compete if you let them. Verify: separate line, separate target.
Score Your Budget
Count the boxes you checked in your size section only. Don’t count the ones from other stages, and don’t give yourself partial credit for things you plan to do in Q1.
Checked 80% or more: Your budget is a real allocation model. Your next gain probably comes from better intake conversion or a service-line shift, not from more spend. The most useful thing you can do is audit what happens to a lead in the 90 seconds after it arrives.
Checked 50% to 79%: You have a functioning budget with one structural hole in it, and it’s almost always one of three things: even allocation across uneven locations, no separate ramp budget for new offices, or lead-counting instead of production-tracking. Fix the structural hole before you add a dollar of spend.
Checked under 50%: You don’t have a budget yet. You have a set of recurring charges. That’s fixable in about 30 days, and the sequence matters: nail down collections per location, get call handling covered, pick two channels, then measure booked and kept appointments for a full quarter before changing anything else.
A last piece of advice that will not be popular with agencies. If you’re under ten locations and someone is selling you a brand awareness campaign, ask them what it’s supposed to do to your schedule in the next 90 days. If the answer involves the word impressions, spend that money on call coverage instead. Brand matters enormously at 30 locations. At four, it’s usually a way to spend money without being accountable for it.
Where to Go From Here
Most DSO marketing budgets aren’t wrong on the total. They’re wrong on the distribution, and the distribution problem is invisible until someone puts spend, booked appointments, and production for every location on the same page.
We’ve written separately about DSO marketing strategy and dental patient acquisition cost, but the budget question is the one worth solving first, because everything downstream inherits it.
Book a free strategy call and we’ll walk your current spend against your location count, your open chair time, and your service-line margins, and tell you where the money is going to waste. No obligation, no pressure to sign anything. If your budget is already allocated well, we’ll say so.