Ask an orthodontist what a click is worth and you'll usually get one of two answers. One is a shrug. The other is a number borrowed from a dentist friend or an agency pitch, with no arithmetic behind it. Both lead to the same place: a budget set by gut, a bid set by fear, and an account that gets switched off the first month it looks expensive.
There's a better way to get the number, and the practice already has every input except one. Start from what a signed case is worth and walk backward, step by step, to the click. This chapter does that walk with real orthodontic figures. Where a figure comes from a vendor rather than a survey, it says so. Where nobody has published a figure at all, it says that too, and gives you a placeholder to replace with your own.
A Signed Orthodontic Contract Is Worth More Than $5,450. Work the Click Price Backward From There.
Our method lays out a chain of six links: what a click costs, how many clicks book an exam, what a booked exam costs, how many exams become cases, what a case costs, and what a case is worth. Most people try to run it forward from the click and get stuck at the second link. Run it backward instead, from the one number your practice knows cold.
That number is the contract. The American Association of Orthodontists doesn't publish an average treatment fee; its own consumer pages say costs vary widely. Practice-management firm Gaidge, which pools data from client practices, reports that contract values "continue to exceed $5,450." CareCredit's cost guide, built on consumer research for the lender, puts metal braces at an average of $6,343 and clear aligners at $5,108. Those are vendor figures, so treat them as a reasonable middle, not gospel.
Your own average contract beats all of them. Pull it from the practice software for the last twelve months, braces and aligners together or separately, and use that. For this chapter we'll use $5,450, the most conservative of the three.
One caution before you average everything together. Treatments don't carry the same value, and a single average hides that. CareCredit's figures put metal braces about $1,200 above clear aligners. One practice in our example market publishes its own table: comprehensive braces and aligners at $6,000 to $8,000, Phase 1 treatment for younger children at $3,000 to $5,000. If your Phase 1 cases are worth half your comprehensive ones, a click on "palate expander" and a click on "braces for adults" deserve different ceilings. Run the chain once per treatment line you advertise, and keep each line in its own ad group so each one can carry its own bid. Chapter 7 turns those ceilings into bids.
Two in Three Kept Exams Become a Case, So a Kept Exam Is Worth About $3,500 in Contracts.
The second number comes from the profession itself. In the AAO's 2025 economics survey, member practices reported that 64% of new patient exams turned into treatment starts in 2024. Some families sign the same day, some think about it for weeks, some go elsewhere, and some children are put on observation. Across all of them, roughly two of every three exams become a case.
So a kept exam carries about 64% of a contract's value: 0.64 times $5,450 is about $3,488. Nobody publishes that figure; we multiplied it ourselves. Keep it on a sticky note anyway, because every bid decision later in this guide leans on it.
One step further back sits the booked exam, and not every booked exam is kept. Gaidge reports that about 81% of scheduled new patients show up. That puts a booked exam at about $2,825 in expected contract value.
Read that as a ceiling. If the account pays more than about $2,825 in ads for each booked exam, the average case loses money before the practice pays for brackets, aligners, staff or rent. Your real limit sits well below the ceiling, because a case has costs. But you finally know where the ceiling is, and it's a lot higher than most practices assume when a single $25 click feels expensive.
At a $20 Click, the Booking Rate Decides Whether the Math Works.
Now come forward from the click. For "near me orthodontist" in our example market, Detroit, Keyword Planner's top-of-page range runs from $5.19 up to $32.12. Expect a different spread where you are. Take $20 as an illustration.
The missing link is the booking rate: how many clicks turn into a booked exam. We looked for a published booking rate for orthodontic Google Ads and found none we'd trust, so here are two placeholders.
If 4% of clicks book an exam, you buy 25 clicks per booking, and a booked exam costs $500. Carry that through the show rate and the close rate and a signed case costs about $964 in ads.
If 8% of clicks book, a booked exam costs $250 and a signed case about $482.
Both sit comfortably under the $2,825 ceiling, which tells you something important before you've spent a dollar: on the searches that book, the account can afford to compete for the top of the page. The practice that won't bid past $8 because "that's what a click should cost" is protecting itself from a deal it should be taking every day.
Those placeholders also show what the volume gate costs. In this method, broad match and automated bidding stay locked until roughly 30 quality conversions land each month. At $250 to $500 per booked exam, 30 a month is roughly $7,500 to $15,000 in monthly spend. That's not a recommended budget; it's the arithmetic of the gate. A practice spending less still runs Isolation profitably, it just stays there longer, and a busy multi-office group may clear the gate in the first month.
The booking rate is also the link a practice controls most directly. A click that lands on a page about exactly the treatment the person searched for books more often than one dumped on a homepage. Chapter 4 builds those pages, one per treatment.
The Front Desk and the Treatment Coordinator Set the Close Rate. Google Can't.
Google Ads can deliver the right person to the exam. It has no say in what happens next. Whether that exam becomes a case is decided by the phone, the front desk, the doctor and the treatment coordinator, the staff member who walks the family through the plan and the payment options.
Speed matters more than most practices think. OrthoFi, a financing and software company, reports from its own data that the likelihood of converting a patient "drops 20% the moment they leave" the office without starting, then decays further over the next two weeks: 35% for children and 45% for adults. A separate software vendor, SmileSuite, reports that about 29% of patients across its practices start the same day. Both are vendor figures from their own customers, but they point the same way: a family that leaves to "think about it" is a family that cools.
The reviews in our example market say the same thing from the other side of the desk. Of 181 low-star orthodontic reviews we read and coded, 55 complained about phones and access, and 69 about time: waits, hard-to-get appointments, treatment that ran long. Those are families the ads paid to bring in.
Now put a number on it. Move the exam-to-case rate from 64% to 70% and every kept exam is worth about $3,815 instead of $3,488, roughly $330 more, without a single extra click. A treatment coordinator who follows up within a day is worth more to the ad account than any bid strategy Google sells.
A Case Pays Out Over 21 Months. The Clicks Are Paid This Month.
There's a timing trap in all of this. The case is worth $5,450, but very little of it arrives this month.
In the AAO survey, patients who financed treatment paid an average of $211 a month over 20.8 months. OrthoFi's data puts the average down payment at $673 and the share of families who pay in full at 22%, vendor figures again. Most of a contract, in other words, trickles in over almost two years, while Google bills for the clicks that produced it right away.
That gap doesn't change whether the ads are profitable. It changes how much the practice can comfortably spend while the money comes in. Set the first budget from what the practice can carry for three to six months without flinching, not from the contract total. An owner who flinches at the week-three invoice tends to pull the plug in week four. That's exactly when Isolation, our label for the hand-bid, exact-match campaign that opens the account, has just collected enough booked exams to show what's working.
Retainers, Phase II and Patient Referrals Pay Off Years After the Contract. The Click Price Comes From the Contract Alone.
A case rarely ends at the contract. Retainers break, get lost and get replaced; one practice in our example market lists retainers at $200 to $400 in its fee table. A child treated in Phase I may come back for Phase II, though Gaidge reports only about 49% do at the average practice. And patients send patients: in the AAO survey, 33% of new patient exams came from patient referrals, a number fed directly by reviews and by how the family felt at the last appointment.
All of that is real value, and it's tempting to fold it into the click math. Don't, at least not at first. A budget built on the contract alone survives a bad quarter; a budget built on lifetime value assumes money you haven't earned yet. Track the extras in the practice software, watch them grow, and let them become the margin that lets you bid a little more aggressively once the account has proven itself.
An orthodontist who would rather have this math run on their own numbers can see what our Google Ads management covers.
Next: An Invisalign Ad Belongs on an Invisalign Page. Chapter 4 Explains Why Google Grades Them Together.
The ceiling on a booked exam is set, and so is a rough price for one. Chapter 2 chose the searches to buy first. Chapter 4 raises the booking rate, the link this chapter left as a placeholder, by matching every ad to a page about exactly what was searched.
This chapter is part of Google Ads for Orthodontists, our sixteen-chapter guide for orthodontic practices anywhere in the US.
