A quick read of how the account moved from losing money to funding its own growth.
0.55× ROAS
2.39× ROAS
55% show up
$113,071 revenue
01 / 04
URBN Dental runs 11 clinics across Houston's highest-income areas. Before we took over in June 2025, Google Ads had spent $42,000 to generate just $23,000 in new-patient revenue, a 0.55× return. Close to $19,000 was lost outright, making the channel cash-negative and unsustainable at that spend level.
Spend concentrated on competitor brand terms, insurance-related searches the practice doesn't accept, and bargain-intent queries such as "cheap," "no cost" and "free," paired with dentist, dentistry and implants.
Success was counted as clicks on the call button, not real calls, and not calls lasting over 60 seconds. Lead quality and actual demand were effectively invisible.
9 of the 11 locations sit within a 6km radius. Budget from one clinic routinely spent on another: one clinic landed zero new patients while another took 70 new patients from a $5,000 budget.
Lead counts looked healthy on the surface. Booked appointments stayed low regardless, spend and real results had come apart.
Exhibit A. The account before the rebuild, spend outrunning results.
Per the same period's patient-value report: average revenue per booked patient was just $899 account-wide, $824 from Google Ads specifically.
02 / 04
No new campaigns and no bigger budget, just fixing what was broken in the structure, the measurement, and the geography.
Systematically excluded the terms that were never going to convert: insurance searches, competitor brand names, bargain-intent queries. Over 6000+ negative keywords added to date.
Re-pointed success metrics to what actually matters: online bookings and booked phone calls, not clicks on a call button.
Google Ads conversion action, live
ActiveLiine New Patient Online Booking
PrimaryConversion sourceWebsiteAll conversions
Replaced broad, overlapping targeting with small, clinic-specific radii, so neighbouring locations stopped bidding against each other. Overlap cut by roughly 0% after testing.
Sample campaign, live targeting
Optimisation scorecustom radius
1.6 mi radius · 510 Chimney Rock Rd, Houston
Daily budget $0 · down from broad, overlapping city-wide targeting
03 / 04
We took over the account in July 2025. That first month, $33,000 in spend generated $79,398 in new-patient revenue, a 2.39× return counting first visits alone. Using conservative dental lifetime-value assumptions, the true revenue impact of that same spend sits between $237,000 and $395,000.
Exhibit C. The account one month after the rebuild.
Average value per patient more than doubled month over month, from $899 in June to $2,036 in July.
Monthly ad spend vs. revenue from new-patient leads, May through January. Striped bars mark months where the source report didn't label an exact revenue figure; height is approximate.
04 / 04
Total revenue tied to Google Ads in January: $95,173 already collected ($82,831 from Google Ads directly, the rest from call extensions), plus 19 future-dated appointments averaging $942 each. Every one of these bookings is non-branded search; nothing here is inflated by brand terms or repeat calls.
Exhibit B. The same account, January 2026.
Blended across every channel, the funnel above converts at 72%. Isolate pure Google Ads clicks and it climbs to 90% (168 booked from 186 leads); call-extension traffic is what drags the blended rate down.
New patient leads
New patient leadsBooked appointments
New patient leads vs. booked appointments, March 2025 through January 2026. Conversion rate rose from 54% to 72% over the same window.
If your paid search spend is hard to defend in a board meeting, we'll show you exactly where it's going and what to do about it.
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