Quick Answer: A practical place to look for more dental revenue is money a practice has already earned but not kept: fees written off on services insurance doesn’t cover, balances that age past the point of collection, and treatment plans patients never schedule. California law shapes each of those levers, so fixing them is part operations, part compliance.
Why is revenue harder to grow in a dental practice right now?
Because what payers pay hasn’t kept up with what a practice costs. The ADA Health Policy Institute reports that since January 2021, the dental reimbursement rate index it tracks, averaged across all payer types, rose 19% while inflation was 27%. Over the same stretch, dental equipment and supply prices rose 23% and dental office staff hourly earnings rose 21%.
Dentists feel it. In the Institute’s survey, insurance issues such as low reimbursement and denials, staffing shortages, and overhead costs were the top three concerns for 2026, and it reports consumer spending on dental care down 2.4% for 2026 through August.
Our earlier guide on how to grow your dental clinic in San Diego covers chair capacity, case mix, hygiene recall and owner dependence. This one covers the other side of the ledger: the revenue a practice produces but doesn’t keep.
That gap can weigh heavily in California. The ADA Health Policy Institute reports that California has the highest share of solo practices among states, at 44%, and in a solo practice, fee decisions and collections can rest with the owner personally.
Are you writing off fees you don’t have to?
Possibly, if your team discounts services the plan doesn’t cover. Under California’s non-covered services law, a dental plan or insurer contract issued, amended or renewed on or after January 1, 2011 can’t require a contracted dentist to accept the plan’s fee for services the patient’s plan doesn’t cover. The dentist may charge up to their usual and customary fee instead.
The catch is the definition of “covered.” The statute treats a service as covered even when the plan pays nothing because of a deductible, an annual maximum, a frequency limit or an alternate benefit. Those fall outside the non-covered services rule, so your contract terms govern them.
So the useful audit is narrow: pull your write-offs by procedure code, separate truly non-covered services from limited ones, and check what your fee schedule charges for the first group. Have your PPO contracts and the codes in question reviewed by counsel before you change what you bill.
The ADA’s practice-management guidance illustrates the difference between gross and net production: a practice that produces $100,000 a month gross can end up with $92,000 net once insurance write-offs, professional courtesies and other adjustments come out.
Should you drop a PPO network to raise revenue?
It may pay to review fees and write-offs first. In the ADA Health Policy Institute’s survey, 35.0% of dentists planned to drop out of some insurance networks in 2026. For 2025, the Institute found dentists largely followed through on their plans, except for dropping out of insurance networks.
By the third quarter of 2026, the Institute reports, dentists had already surpassed their stated intentions for joining dental insurance networks. Leaving a network is a bigger decision than it looks from the fee schedule alone.
A cleaner sequence is to measure what each network actually pays per procedure after write-offs, fix the non-covered write-offs above, and only then weigh which contracts to renegotiate or leave. The answer may differ by plan, and by how many of your patients each plan brings.
How much of what you produce do you actually collect?
It’s a useful number to know before other revenue plans. Track what you collect against net production each month, and watch for the gap to widen, since we found no primary source that publishes an average collection rate for dental practices.
California changed one collections tool recently. Under Civil Code section 1785.27, as amended by SB 1061, medical debt owed to a provider can’t be reported to credit bureaus, and a written contract creating medical debt on or after July 1, 2025 must include a specific clause or it’s void and unenforceable. The law reaches debts owed to dentists, with exceptions, so have counsel review your in-house payment-plan contract template and how the statute applies to your balances.
For qualifying medical debt owed directly to a provider, reporting the balance to a credit bureau is no longer available as a collection tool. Collecting the patient’s share at the time of service, and setting payment plans in writing before treatment starts, do more of the work.
How can a practice offer patient financing under California law?
Carefully, because California regulates how dental offices arrange third-party credit. Business and Professions Code section 654.3, rewritten by SB 639 and operative since July 1, 2020, bars an office from arranging deferred-interest credit and bars staff from filling in any part of a patient’s credit application.
The same section adds rules worth turning into a front-desk checklist:
- A written treatment plan comes first, listing each service, its estimated cost and, where the office takes assignment of benefits, the patient’s estimated share of cost.
- Credit arranged in the office can’t be charged more than 30 days before treatment, with an exception for orthodontics.
- No credit application while a patient is under general anesthesia, conscious sedation or nitrous oxide.
- The office must provide a written or electronic notice, on one page or screen, in at least 14-point type, and obtain the patient’s signature.
Patients can still pay with a deferred-interest card they got on their own. But in an April 17, 2026 consumer alert, California’s Attorney General told patients to ask for a payment plan directly with their dentist instead of a third-party lender, so a clear in-house payment plan is worth having ready.
How do you get more patients to accept treatment plans?
Start with cost. The ADA Health Policy Institute links falling dental spending in part to fewer patients accepting treatment plans, and its 2022 data show 13% of people reported cost barriers to dental care, compared with 4% to 5% for other health care services.
Insurance changes the conversation. The Institute found people with private dental benefits face lower cost barriers than people with public dental insurance or none, and the California Dental Association says patients with some form of dental coverage are more likely to accept a treatment plan. For uninsured patients, a clear payment option may matter more.
Before an office arranges third-party credit, California’s financing rule requires an itemized written plan, and if the office accepts Medi-Cal, the plan for a Medi-Cal patient must say whether Medi-Cal would cover an alternate, medically necessary service. A plan that clear, presented with a lawful payment path, may be easier to say yes to than a verbal estimate.
Membership plans for uninsured patients are another route. Our guide to dental practice marketing strategies covers them, and any in-house plan design is worth reviewing with counsel before launch.
Does Medi-Cal affect your revenue plan?
If Medi-Cal patients are a large share of your schedule, yes. California’s 2026-27 budget delayed the end of the Proposition 56 supplemental Medi-Cal dental rates to July 1, 2027, so current rate levels are scheduled to hold until then. The California Dental Association says those supplemental rates make up 40% or more of total Medi-Cal dental reimbursement.
That’s a dated risk in your payer mix, and it’s worth planning around now. A practice that depends on Medi-Cal revenue should know what share of collections those rates support before mid-2027.
How do buyers read these revenue levers?
Treat them as records to have ready. If you’re considering a sale, organize your procedure-code write-offs, receivables aging and payment-plan contracts for review by your advisers. Getting them in order also shows you, before anyone else looks, where revenue is slipping.
Clean records don’t guarantee a price. If you’re weighing a sale in the next few years, a financial analysis of your practice can show which of these levers is worth fixing first, and our page on how to sell a dental practice explains the process. If timing is the question, our guide on whether it’s hard to sell a dental practice in San Diego covers it.
About Aesthetic Brokers
Aesthetic Brokers is a sell-side advisory firm. We never represent buyers, so there’s no conflict about whose side we’re on. Founder Bill Walker led mergers and acquisitions for a large private-equity-backed healthcare services organization before founding the firm.
We work with cosmetic and specialty dental practices weighing a confidential sale or recap, and our dental growth consulting helps owners strengthen the practice before any transaction. For a practice-specific conversation in San Diego, call 619-742-0310.