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BlackpeakCFO Fractional Controller & CFO
US Bookkeeping · Specialist Niche

Dental Practice Bookkeeping $495/mo · Single CGMA · Month-to-Month

Production vs collection variance, insurance write-off tracking, Section 179 on equipment, and per-provider P&L — for solo and 2-doctor practices doing $600k to $3M in annual collections.

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Why Generic Bookkeepers Fail Dental Practice

Dental practices have a unique revenue model that breaks generic bookkeeping. Three numbers matter: production (the gross value of services rendered at full fee), adjustments (insurance write-offs, contractual adjustments, professional courtesy, no-charge), and collections (cash actually received). The gap between production and collection is typically 20-35% — most of it insurance write-off, some of it accounts-receivable timing. A practice doing $2M production might collect $1.4M, and if your bookkeeper does not separate adjustments from bad debt, you have no idea whether your fee schedule, insurance mix, or AR management is the problem. The next issue is equipment: a dental practice runs $200k-$800k of capital equipment (chairs, imaging, mills, cone-beam CT). Section 179 (up to $1.16M expensing in 2026) plus bonus depreciation (60% in 2026, phasing down annually) can let you expense most of a new equipment buy in year 1 — saving $40k-$150k in federal tax depending on bracket. But the election strategy depends on income, basis, and forward earnings — you cannot decide at the last minute. Multi-doctor practices add the per-provider profitability question: each doctor has their own production, their own write-off pattern, their own lab cost, their own assistant time. Without per-provider P&L you cannot price an associate buy-in or evaluate a partner.

The Specific Pain Points We Handle

These are the niche-specific issues a generic $200/mo bookkeeper either misses or charges extra for.

1

Production-to-collection gap (typically 20-35% from insurance write-offs and AR timing) is invisible without separate tracking — generalist bookkeepers post the deposit and lose the adjustments

2

Insurance aging buckets (30/60/90/120+ days) matter operationally; PPO write-offs vs bad debt vs timing are different decisions and require different categorization

3

Section 179 + bonus depreciation on equipment ($1.16M / 60% bonus in 2026) can save $40k-$150k in tax — getting the schedule wrong creates basis problems

4

Multi-doctor practices need per-provider P&L (production, adjustments, collections, lab, assistant time) for buy-in valuation and associate compensation

Software stack we use for dental practice bookkeeping

Dentrix, Eaglesoft, or Open Dental (practice management)QuickBooks Online (Plus or Advanced) or XeroCareCredit and Sunbit (patient financing)Gusto, ADP RUN, or BambooHR (payroll)Dental Intelligence or Practice by Numbers (KPI dashboards)Veradigm or Vyne Trellis (insurance eligibility and EDI claims)

Dental Practice Bookkeeping — Pricing Comparison

The dental bookkeeping SERP is dominated by local CPA firms with no transparent pricing ($600-$1,500/mo typical) and dental-specific consultancies (Eagle Practice, Stratton) that bundle bookkeeping into $3k+/mo coaching packages. Generalist services like Pilot and Xendoo do not understand insurance reimbursement timing, write-offs, or production vs collection — the operational metrics dentists actually run on.

Provider Monthly Focus Notes
Bookkeeping + tax + advisory bundle
Bookkeeping + practice coaching + KPI dashboards
Generalist monthly close
Production/collection split, AR aging, §179 modeling, CGMA review
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FAQs

How do you separate production, adjustments, and collections?

Every month we pull three reports from your practice management software (Dentrix, Eaglesoft, Open Dental): production by provider, adjustments by category (insurance write-off, contractual, courtesy, refund), and collections by source (insurance, patient, financing). Production posts as gross revenue. Adjustments post as a contra-revenue account broken out by category. Collections reconcile to deposits in QBO. The 1-page management P&L then shows: gross production, total adjustments (as a percent of production — your "PPO write-off percentage"), net production (effectively collected revenue), and AR aging. You can see at a glance whether write-offs grew this month, whether AR is creeping into 60+ days, and whether your fee schedule is keeping pace with adjustment rates.

I am buying a $180k CEREC mill. Should I §179 it?

Probably yes, with caveats. Section 179 in 2026 lets you expense up to $1.16M of qualifying equipment in the year of purchase, phasing out dollar-for-dollar above $2.89M total equipment. Bonus depreciation is 60% in 2026 (phasing down to 40% in 2027, 20% in 2028, gone in 2029). On a $180k CEREC: §179 the first $130k (limited only by your taxable income — §179 cannot create a loss), bonus-depreciate the remaining $50k at 60% = $30k more, and MACRS the residual $20k over 5 years. Total year-1 deduction: roughly $160k. In a 37% bracket that is ~$59k in federal tax savings. But: if your practice taxable income is only $90k, §179 caps at $90k and the rest goes to bonus + MACRS. We model both scenarios with your tax preparer in November before the equipment closes.

My associate is on a 30% production-based comp. Can you produce her P&L?

Yes — and you need it before the next associate review. We set up each provider as a class in QBO with the practice management software exporting production by provider monthly. Direct costs (lab fees on her cases, assistant time allocated by chair-hour, supplies prorated by production share) post to her class. Indirect costs (front desk, sterilization, rent) allocate by production percentage or chair-hour as agreed. Output is a monthly per-provider P&L showing her production, her direct costs, her share of indirect, and her contribution margin to the practice. That number drives buy-in valuation, associate raises, and partner discussions. Without it you are negotiating in the dark.

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