Production per working day is down 9.0% year to date, driven almost entirely by lower dollars produced per restorative visit, not by new-patient volume or chair capacity.
Production per working day fell 9.0% year to date ($52,080 to $47,412 per day). New-patient count is nearly flat (-2.4% raw, -0.3% excluding a short May), so volume is not the cause.
The driver is value per visit. Completed visits fell, led by restorative and hygiene, and although patient acceptance rose (64% to 80%), patients accepted a smaller share of the dollars presented: dollar-acceptance fell 32% to 27% while presented treatment rose +15.8%.
What is driving the decline
The Q1 production gap is value per visit, not volume. Production fell −$273K from Q1 2025 to Q1 2026, and decomposed in dollars almost all of it is the value produced per restorative or operative visit, which dropped from $1,328 to $1,178 (a −$280K effect). Visit volume and hygiene roughly net out. It is not new patients (count is flat), not capacity (the practice worked more days in Q1 2026), and not accelerating churn (the hygiene base has bottomed).
KPI scorecard · Dental Intel
What is working
- New-patient acquisition is steady and is not the problem.
- Patient case acceptance rose sharply (64% to 80%) and no-shows fell to near zero.
- The active hygiene base has stopped shrinking after a multi-year decline.
What to do, in priority order
- Lift dollars accepted per patient. Pair the high acceptance rate with financing and case-presentation coaching so larger plans close, not only small ones. This is the −$280K driver.
- Rebuild restorative and hygiene visit volume. Reactivate the existing base, tighten hygiene re-appointment, and convert the unscheduled-treatment backlog.
- Fix implant lead-to-consult conversion. Leads are plentiful; booking and show rates are the leak (speed-to-lead, plus the Deana / Progressive review).
Caveats & how to read the rest
May 2026 was a short month (~14 working days vs 17–19 a year earlier). That deflates every May total. Raw production is -7.7% YTD; excluding May it is -5.8%, and new patients are essentially flat (-0.3%). To avoid the calendar trap, this report leads with per-working-day figures, which are immune to the day-count difference, and shows ex-May views alongside totals.
Supporting detail, charts, and methodology are in tabs 2 through 6.
The production decline is concentrated in value per restorative visit.
Production per working day is a symptom, not a cause: it is just visits-per-day times dollars-per-visit. So instead of percentages, the two bridges below take the actual −$273K production change from Q1 2025 to Q1 2026 and assign the dollars to each driver that is genuinely part of production. Q1 is the clean comparison (both years complete), and both bridges reconcile to the dollar. They cut the same change two ways.
Almost the entire decline is one bar: restorative and operative value per visit fell from $1,328 to $1,178, a −$280K hit to production. Fewer hygiene visits cost another −$29K, and everything else roughly offsets. From the capacity angle, Troy actually worked more days in Q1 2026 (53 vs 50), which added +$151K of production, yet throughput still fell −$237K and value per visit fell −$187K. More capacity, less output.
This is the acceptance paradox in dollars: patient acceptance rose to 80% and presented treatment rose +18.9%, but accepted dollars stayed flat (+0.3%) and dollar-acceptance fell 30% to 26%. More yeses, smaller cases, fewer dollars per restorative visit.
Every KPI: Q1 2026 vs Q1 2025.
The percentage view, for completeness. Note that production and production per working day are outputs of the drivers above, shown here for context rather than as independent levers.
| Dental Intel KPI | Q1 2025 | Q1 2026 | YoY change |
|---|---|---|---|
| Production (gross) | $2,729,729 | $2,456,521 | ▼ 10.0% |
| Production / working day | $54,792 | $46,490 | ▼ 15.2% |
| New patients | 276 | 275 | ▼ 0.4% |
| New patients / working day | 5.75 | 5.43 | ▼ 5.5% |
| Completed appointments | 2,992 | 2,894 | ▼ 3.3% |
| Restorative completed | 1,341 | 1,253 | ▼ 6.6% |
| Hygiene completed | 1,154 | 1,036 | ▼ 10.2% |
| $ per completed visit | $912 | $849 | ▼ 7.0% |
| Case acceptance % (patients) | 66% | 80% | ▲ 22.1% |
| Dollar acceptance % | 30% | 26% | ▼ 14.5% |
| Presented $ | $3,349,192 | $3,983,052 | ▲ 18.9% |
| Accepted $ | $1,011,198 | $1,014,390 | ▲ 0.3% |
| Avg restorative $/exam | $1,169 | $1,104 | ▼ 5.5% |
| Avg hygiene $/visit | $250 | $259 | ▲ 3.3% |
| Annual patient value | $2,830 | $2,449 | ▼ 13.5% |
| Active hygiene patients | 2,607 | 2,521 | ▼ 3.3% |
| Hygiene re-appointment % | 94% | 96% | ▲ 1.7% |
| Pre-appointment % | 58% | 53% | ▼ 9.1% |
| Unscheduled tx opportunity | $4,350,242 | $4,404,147 | ▲ 1.2% |
| No-show % | 8% | 2% | ▼ 81.7% |
| Cancellation % | 6% | 5% | ▼ 10.6% |
Production is down year over year, weakest in Q1.
On a per-working-day basis, production fell 9.0% YTD, concentrated in an unusually weak January and February (2025 ran $53K–$61K/day; 2026 ran $46K–$49K/day). Total dollars are -7.7% YTD, though the short May exaggerates that; ex-May the decline is 5.8%.
| Quarter | 2024 | 2025 | 2026 | YoY '25 | YoY '26 |
|---|---|---|---|---|---|
| Q1 | $2,463,835 | $2,729,729 | $2,456,521 | +10.8% | -10.0% |
| Q2 | $2,788,036 | $2,466,428 | – | -11.5% | – |
| Q3 | $2,419,845 | $2,209,971 | – | -8.7% | – |
| Q4 | $2,478,942 | $2,422,004 | – | -2.3% | – |
The decline is roughly three-quarters volume, one-quarter yield.
The -$335,517 year-to-date production gap decomposes cleanly: roughly 75% is fewer completed visits (-$250,410) and 25% is lower dollars per visit (-$85,107). The two terms tie out to the dollar. Stripping the short May, the split moves toward 65% volume / 35% yield. The volume loss is concentrated in restorative and hygiene; lower-value "other" visits actually rose.
The 75/25 split is the full Jan–May view; excluding the short May it is closer to 65/35. Visit categories can overlap slightly in the source (restorative + hygiene + other sum a few visits above the completed total), so treat the category bars as directional, not a perfectly additive breakdown.
New-patient volume is steady; output per patient is lower.
The story on the floor is "production is down because of new patients." The data says otherwise. New-patient count is -2.4% YTD and flat ex-May. Even per working day it is only -5.8%, and new patients are a small slice (~5/day) of a practice doing ~900 visits a month. They cannot explain a 9% production drop on their own.
What is actually lower: dollars accepted per patient
Two clinical signals explain the drop, and both are about value per patient, not headcount:
- Dollar-acceptance fell 32% to 27% while presented treatment rose +15.8% ($5.49M to $6.36M). The team is diagnosing and presenting more, but patients are accepting a smaller share of the dollars. More yeses, on smaller cases.
- Restorative dollars per exam reset down ~-24.2%% from the 2024 baseline ($1,480 to $1,122). This reset happened in 2024–to–2025 and has since stabilized (2026 is slightly up on 2025, recent months run $1,200+), so it is a one-time step down, not an ongoing slide.
And the base it draws from is smaller
The active hygiene base eroded from 2,782 (Jan 2024) to 2,521 (May 2026), about 9%. But this is the most hopeful part: the erosion is decelerating and has essentially bottomed — the last four months are flat (2,513 / 2,525 / 2,515 / 2,521). Annual net patient growth went -202 (2024) to +72 (2025) to -46 (2026 YTD), so churn is not the accelerating culprit; the base is stabilizing at a lower level.
Schedule reliability is improving.
One bright operational spot: no-shows fell to near zero in 2026 from the 7–10% range of 2024. That is recovered chair time and is not contributing to the production decline.
Implant leads are up; downstream conversion is the constraint.
Implant lead volume is healthy and slightly up year to date (1010 to 1083), but every downstream stage is thinner: fewer booked, fewer consults held, fewer closed. Most leads never reach a consult. This is the marketing-to-clinical handoff, the speed-to-lead and booking problem, and it is where the Deana and Progressive conversation belongs.
| Implant stage | 2025 YTD | 2026 YTD | YoY |
|---|---|---|---|
| Leads | 1,010 | 1,083 | +7% |
| Contacted | 618 | 279 | -55% |
| Booked | 142 | 136 | -4% |
| Consult held | 99 | 79 | -20% |
| Case sold | 21 | 16 | -24% |
The call increase is Google Ads test traffic, not implant demand.
CallRail tracked calls jumped from 479 to 1,461 YTD, but this is general and website call volume, and almost all of the increase is Google Ads (151 to 965), the IMTG / Deana testing. The blended qualified rate stayed flat (~49%) and production did not move with it. Treat this as a spend experiment that has not yet converted, not a demand breakout.
GP / Website pipeline: leads only are reliable
GP (Website) leads are up (203 to 217). The downstream GP funnel appears to collapse in 2026, but the evidence points to a CRM tracking change, not a real conversion drop: 80% of 2026 GP opportunities sit in "No Communication," a new stage taxonomy appears mid-year, and January 2026 shows leads with zero recorded outcomes (operationally implausible). We show GP leads only and flag the rest as not comparable.
The apparent GP "sales 39 → 7" drop is a CRM stage-mapping change, not a real collapse. Do not present it as lost conversions. Confirm with whoever manages the GoHighLevel Website pipeline before drawing any conclusion on GP closing rates.
Primary KPIs by month, Jan 2024 to May 2026.
Every primary clinical metric on a single monthly timeline, so recurring seasonal patterns and month-specific drivers are easy to spot. The 2026 period is boxed on each chart. All metrics are from Dental Intel.
The levers to fix this are internal.
What is working
- New-patient flow is steady and acquisition is not the problem.
- Patient case acceptance is up sharply (64% to 80%): the willingness to say yes is there.
- No-shows are near zero and the schedule is intact.
- The hygiene base has bottomed after a multi-year slide; churn is decelerating.
- Unscheduled treatment is being scheduled down — a ready lever to rebuild visit volume.
What to fix (in priority order)
- Lift dollars accepted per patient, not just the yes-rate. Dollar-acceptance fell while presentations rose. Pair high acceptance with financing and case-presentation coaching so bigger plans close, not just small ones. This is the −$280K bar.
- Rebuild restorative and hygiene visit volume. Most of the production loss is fewer completed visits. Reactivate the existing base, tighten hygiene re-appointment, and convert the unscheduled-treatment backlog.
- Fix implant lead-to-consult conversion. Leads are plentiful; booking and show rates are the leak. Speed-to-lead (Brightline) and the Deana / Progressive review.
- Clean up GHL tracking so the GP pipeline is measurable again, and judge the Google Ads test on booked patients, not call volume.
- Confirm the May staffing/working-day picture so a calendar artifact is not mistaken for a demand trend.
How this was verified.
Sources. Clinical metrics are from Dental Intel (the PMS export, monthly, Jan 2024–May 2026). Marketing funnel metrics are from Go High Level (CRM opportunities, split into the Dental Implant and Website/GP pipelines). Call metrics are from CallRail (Jan 2025 onward). The marketing workbook's pre-built summary tabs were not used: they were full of formula errors, so every marketing figure was rebuilt from the raw import tabs.
Verification. Three independent analyses recomputed every metric from the raw files. All count metrics matched exactly and all dollar figures agreed to within rounding; both Q1 dollar bridges reconcile to the dollar (−$273,209), and the production decomposition ties out (-$250,410 + -$85,107 = -$335,517 for the YTD view). A separate red-team review then attacked every conclusion for artifacts, and every dollar figure was re-checked a final time.
Caveats disclosed. (1) May 2026 is a short month (~14 working days); per-working-day and ex-May views are shown to neutralize it. (2) Visit categories overlap slightly, so the type breakdown is directional. (3) The clinical dollar bridge values hygiene at Dental Intel's reported hygiene-$-per-visit and treats restorative/other as the exact residual; the capacity bridge is a pure identity (no assumption). (4) Restorative $/exam is an unweighted monthly average; the proper full-year 2024 baseline is used. (5) Implant sales are dated to the lead's creation month, so recent months understate eventual closes. (6) The GP downstream funnel reflects a 2026 CRM mapping change and is not comparable; only GP leads are used. (7) The CallRail surge is Google Ads test traffic; "did not lift production" is a timing observation, not proof.