A defensible, citation-backed reference for HIP & Neon Canvas Practice Growth Advisors. Use it to answer the question every client asks — "What value should I put on a new patient?" — with the right number, by specialty, payer mix, and region, every time.
Specialty case fees have likely drifted +3 to 8% since publication; apply an inflation lift when quoting 2026 numbers to clients. State Medicaid rates (ADA HPI) refresh each October; BEA Regional Price Parities each February (we’re current). See Methodology → Freshness Table for source-by-source vintage. Time-sensitive: California Prop 56 sunsets July 1, 2026 — see the CA Spotlight.
The calculator stacks four adjustments on top of the specialty baseline to land at a number you can defend in a client meeting. Here’s what each one means — in plain English — before you dive in.
Each one has a different math model — recurring lifetime (GP, peds, DSO) vs. single-case (ortho, OMS, cosmetic). The calculator switches automatically.
Tells the calculator how patients pay — cash, in-network insurance, or Medicaid. This determines how much of the charged fee actually collects.
Cost of living, PPO write-off pressure, and Medicaid rates all vary by region. This multiplier stacks on top of payer mix.
Gross for client conversations. Net for the CFO. Profit for setting CAC ceilings. When unsure: lead with Gross.
Pick a specialty, dial in the payer mix and region, and the math renders live with every assumption traced to a cited source. Hand the client the equation, not just the answer.
Use the recommended column when a practice can’t pull PMS-grade data. Low / Mid / High span the defensible range across payer mix, region, and case acceptance.
Concrete narratives a PGA can use on a client call today that the 6-region model can’t surface. These are the five state-specific stories driving the biggest swings in defensible LTV across the U.S. as of 2026.
Ohio raised dental Medicaid rates 93% on average in the 2024 budget. Active Medicaid-treating dentists rose from 18% to 31% in one year. Pediatric Medicaid practices in OH now operate at near-PPO economics — a complete repricing of LTV.
Allocated $78M in the FY24-25 budget to raise rates. Reportedly the highest reimbursement state in the country. Medicaid-heavy practices in CO have nearly FFS-grade economics — rare in the U.S.
The Prop 56 dental incentive payments — ~$504M preserved in 2025-26 after Newsom proposed elimination — will fully discontinue on July 1, 2026. Material LTV downside for any CA Medicaid-heavy practice. Re-run CA client baselines now — payments stop in weeks, not months.
Question 2 (Nov 2022, passed 71.3%) imposed an 83% dental MLR on insurers. They must rebate excess; the state can block "unreasonable" rate hikes. Reshapes commercial economics on the practice side — not a Medicaid story, but a real PPO collections story.
Confirmed: AL is the only state in the U.S. with no adult dental Medicaid coverage outside of pregnant/postpartum (60-day) enrollees. Children covered normally via EPSDT. For AL practices, the Medicaid funnel is pediatric-only — adjust marketing economics accordingly.
Utah · 1115 Waiver effective April 2025 expanded adult benefits.
Georgia · moved from emergency-only to enhanced coverage in 2025.
Maryland · adult Medicaid ~86.5% of private — top-tier.
Virginia · ~78.4% of private — top-tier.
Calculation. Production per visit × visits per year × retention years. Per-visit production runs $225–$275 in PPO-heavy practices and $325–$400+ in FFS practices, with national mid-point near $2598. Visits/year sit at 1.7–2.0 (twice-yearly hygiene plus restorative).
Retention. ADA average is 8–10 years; Henry Schein and Dental Intelligence cite 17% annual attrition (~6-year effective life) for average practices and 3% (30+ years) for the top decile10.
Bounded LTV. Pediatric is age-gated. A typical patient enters age 1–3 and ages out to a GP around 13–18, giving 10–15 years of tenure with 2 visits/yr. Production/visit: $180–$280 (preventive-heavy, sealants, fillings, space maintainers, sedation).
Household LTV is the metric that matters. Average U.S. household has 1.9 children6. AAPD consultants use a 2.0–2.5× household multiplier — siblings book together and one parent’s decision lands the whole family. Recommended baselines: $9K–$13K private/PPO, $3.5K–$6.5K Medicaid.
Pediatric practices that refer to in-network ortho (or run their own) capture a second $5,500–$6,200 case per child needing comprehensive treatment. Roughly 50–60% of pediatric patients receive ortho24. Add a weighted $2,500–$3,500 per-child when the practice has an ortho component.
Validated. The current baseline lands almost exactly on the published mean. The 2024 Roger Levin orthodontic survey reports the average bracket-and-wire case fee at $6,121 and clear aligner at $6,373, both flat from 20235.
The AAO 2025 Economics of Orthodontics survey corroborates record case volumes (287 annual starts/orthodontist on average, high performers at 336+)4. Cain Watters reported 5–6% increase in gross production and net collections in 202412. Bentson Copple Patterson valuation data confirms these ranges with overhead targets 50–57% for ortho vs. 59–62% for GP7.
Some practices generate $1,000–$1,500 in Phase I and $4,500–$5,500 in Phase II16, but the per-patient total still lands in $6,000–$7,000. Sibling households common → 1.5–1.8× household multiplier.
OMS is not a recurring LTV model. Practices run on single-encounter referrals from GPs and pediatric dentists. "Lifetime" is usually one episode of care. Standard LTV math overstates the number badly. Track two separate funnels with different economics:
Wisdom teeth, single extractions, biopsies: $600–$2,500 per case — mid case $1,800. Patient doesn’t return unless a new problem appears years later.
Single implant: $3,000–$6,000 per tooth all-in. All-on-4 / All-on-X full-arch: $18,000–$38,000 per arch; full-mouth $36,000–$76,00019. Episodic, high-ticket, one-time.
Treat per-case value as the marketing attribution number, not multi-year LTV. Most cosmetic patients return to a general dentist for maintenance. A small fraction become recurring; true lifetime can reach $25,000–$40,000 only when the cosmetic practice is also full-service.
More lifetime revenue per patient. Hygiene, restorative, ortho, implants, cosmetic, and endo all stay in-house. Production/visit $275–$425 (broader mix). Visits/year 2.0–2.5 including specialty visits. Retention 6–10 yrs — slightly shorter than solo GP because DSO doctor turnover causes churn.
DSOs like Heartland, PDS, Aspen, and Smile Brands report higher production per chair than independents due to scale efficiencies15. Overjet’s benchmarks put DSO/multi-doctor at $850K–$1.1M revenue/dentist vs. $650K–$1.13M for solo11.
Two patient types. Single-episode referral work (SRP, gum graft, perio surgery) and recurring perio maintenance every 3–4 months for life, increasingly with the practice placing implants.
Most perio is PPO-billed with substantial write-offs on SRPs (D4341/D4342). Implants are largely FFS. Periodontists average $330K–$370K nationally per 2025 HireSmiles data17.
Almost entirely single-case referral work. Root canals run $1,200–$2,000 per tooth depending on anterior / bicuspid / molar. The patient does not come back to the endodontist unless another tooth needs treatment.
ADA HPI notes endodontists are consistently the second-highest-earning specialty after OMS, with average net income around $299K1. GPs perform two-thirds of common endo procedures — endodontist referral volume is driven by complexity (molars, retreats, surgical endo).
Highest single-case value of any specialty. Full-mouth rehab, complex implant restorative, advanced cosmetic. Case range $20,000–$80,000 per Overjet’s published prosthodontic data11. Single-case dominates; some patients return for additional arch work or maintenance crowns.
Largely FFS / cash / financing. Insurance rarely covers more than a small portion. Average net income per ADA is $200K–$212K despite high case values because lab fees consume a larger share. 2025 HireSmiles average: $323K nationally17.
Three variables drive regional variance: Medicaid reimbursement as % of private, PPO write-off variance, and cost of living. Below is directional sensitivity by specialty, with ADA HPI 2024–25 data as source2. For state-level granularity, use the calculator’s State selector — it stacks BEA Regional Price Parities25 on top of state-specific Medicaid rates for the three A-tier specialties.
Northeast 35–42% · Southeast 32–40% · Midwest 30–38% · Southwest 35–42% · West/Pacific 38–45% (highest) · Mountain West 28–35% (lowest)9.
Ohio raised Medicaid dental rates 93% on average — pediatric Medicaid LTV moves materially upward. Re-run client baselines2.
Whenever possible, use the practice’s actual PMS data — defaults are a starting point only. Below is the exact path in every major dental PMS10.
Not every specialty has the same depth of public state-level data. The calculator stacks state Medicaid context + BEA Regional Price Parities25 on top of the national baseline. How that layer is applied depends on the specialty’s data confidence:
State wages (BLS OEWS)29, state Medicaid rates (ADA HPI 2024–25)2, workforce density (KFF + HRSA)27, and pediatric-specific Medicaid rates (AAPD 2024)28 are all directly measurable. Full state-level math applies.
State Medicaid + cost-of-living measurable; case fees fall back to national baselines (no public AAOMS state fee data; DSO revenue not disclosed by state). ADA HPI publishes DSO affiliation rate by state for the modality view.
State adjustment is modeled from cost-of-living proxy only. Case fees and write-offs use national baselines. Most adult Medicaid programs don’t cover these procedures, and BLS rolls perio/endo/cosmetic into 29-1029 (no separate state wages). Flag explicitly to clients when quoting state-level numbers for these specialties.
State Medicaid values track ADA HPI’s October release (~30 min refresh). BEA Regional Price Parities update each February (~30 min). BLS OEWS state wages release each May (~1 hr). Plus quarterly news monitoring for state-level policy changes (CA Prop 56 sunset July 2026, MA MLR, OH/CO/UT rate moves). Total: ~4 hours/year.
Source-by-source vintage as of May 2026. FRESH = the most recent annual release is in hand. RECENT = within 12 months. AGED = 12–24 months old but still authoritative because the underlying survey is annual — apply inflation adjustments where noted. EXPIRING = a policy change is imminent.
Total production trailing 24 months ÷ unique active patients in the same period = annual production per active patient. Multiply by retention years (or use 1 / annual attrition).
Use the recommended baseline from the executive summary, then adjust by payer composition.
Stack on top of the payer adjustment.
Gross is the right number to lead with for clients. Net (gross × (1 − write-off %)) and profit (net × (1 − overhead %)) constrain CAC budgets.
Pull total production × unique active patients for trailing 24 months. Patient List report (last visit 18+ months) gives attrition.
Office Manager → Reports → Management → Practice StatisticsSame calc. Default "active patient" = 18 months which matches industry standard.
Reports → Practice Management → Production AnalysisProcedures grouped by patient + No Future Appointment report. PPO Write-offs Report gives gross-to-net directly.
Reports → Standard → Production and IncomeCurve has a native LTV/CLV report in Insights that does the calc automatically on the analytics tier.
Insights → Production Reports → Production per PatientProvider-level production per active patient. Enterprise reporting allows cross-location LTV — key for DSO/multi-loc clients.
Reports → Production → Provider/Patient ProductionOverlay on multiple PMSes. If the client has Dental Intelligence, treat it as the source of truth.
Dashboard → Patient LTV widgetHover any pink superscript anywhere on this page for the source. Numbers cluster across CPA-grade and marketing-grade sources — we’ve normalized to defensible mid-points.
Sophisticated PE-backed groups and DSOs will push back on any LTV figure that isn’t grounded in their own PMS data. The right move is always: “Here’s the industry baseline, here’s the regional and payer-mix adjustment, and here’s what we’ll pull from your Dentrix/Eaglesoft/Denticon report to validate it within 30 days.” That answer wins the credibility argument.