01 / 03

Paid Search Review · Peninsula Center of Cosmetic Dentistry · Los Altos

What I'm seeing from an outside look

The account had a strong January. Something shifted in February that the account hasn't recovered from. Most of the infrastructure is in place — the question is whether the strategy choices made in Q1 are still the right ones for the practice.

January

107 conv

CPA $66

Brand on. Cosmetic LP test on. PMax original on. Five channels firing.

February

40 conv

CPA $269

Brand, LP test, Near Me, After Hours paused. Original PMax winding down.

March

19 conv

CPA $284

New PMax replacing old. Emergency campaign launched.

April

32 conv

CPA $308

Emergency still under-converting. CPA highest of year.

May (to 13th)

13 conv

CPA $266

Pacing similar to April. No recovery yet.

Where infrastructure is solid

The agency has done real work the practice should keep

Three thousand-plus negative keywords across six shared lists, ten-line service segmentation (Cosmetic, Crowns, Sedation, Emergency, General, plus paused Bonding / Smile Makeover / Invisalign), proper Performance Max architecture when it was running, and a long-tail keyword list anchored to Los Altos. This is above the typical dental-agency baseline.

Where the opportunity sits

January's winners are still paused four months later

Brand campaign delivered $9 CPA at 86% conversion rate in January, then was paused. Cosmetic LP #2 delivered $54 CPA, then was paused. Original Performance Max delivered $33 CPA on 62 conversions, then was paused (Google flagged it "limited by policy" — fixable). After Hours delivered $38 CPA, then was paused. Five top performers, all still off.

Speaker notes · Slide 1

Open with the timeline. "I pulled the YTD numbers for Los Altos and the picture is interesting. January was the strongest month of the year — 107 conversions at $66 each. The next four months averaged around $280-$300 each."
Frame what changed. "Five campaigns that were producing in January got paused around the end of January or in February. They haven't come back."
Give the agency credit first. "WNDR has done real work here. Three thousand-plus negative keywords. Proper service-line splits. The campaign architecture is better than most dental practices I see."
Don't blame, ask. "I want to understand what happened around February. It might have been intentional — there's a story there only the agency knows. But from the outside, the changes haven't recovered the January efficiency yet."
Bridge to slide 2. "I have three specific questions I think are worth asking them, and one strategic conversation worth having about audience targeting."

02 / 03

Strategic Questions for the Agency Conversation

Four questions worth asking WNDR this month

These aren't accusations. Each one is something an experienced agency might have a good answer for. The conversation itself is the value — and the answers will tell us whether to dig deeper.

Question 1 · Campaign Strategy

"Why is the Brand campaign paused, and is that worth revisiting?"

When it was running in January, Brand delivered 6 conversions on $55 spend at $9 CPA and 86% conversion rate. There's a defensible reason to pause Brand (existing patients dominate brand search, so the agency might be filtering for "new patient only"). But four months later, no Brand campaign means competitors can win clicks on the practice name and the doctors' names. Ask: what's the conversion-quality story behind the pause, and what would need to change to turn it back on?

Question 2 · Performance Max

"What's the plan to resolve the Performance Max policy limitations?"

The original Performance Max delivered 69 conversions at $33 CPA across ten themed audience segments — the strongest performer in the account. Google flagged "most asset groups limited by policy" and it was paused rather than fixed. The replacement Performance Max is running at $123-146 CPA. The policy issue is likely "Award-Winning" / "Nationally Recognized" claims that Google now requires verifiable sources for. Fixable in an afternoon. Ask: can we work the policy fix together this month and reactivate the original PMax?

Question 3 · Conversion Tracking

"Book Appointment shows zero conversions in 133 days — is the trigger broken?"

The account has four conversion actions configured. Three are firing: Phone Call Lead (588 YTD), Submit Lead Form (116), Contact (220). One has fired zero times since January 1: Book Appointment. Most likely the booking widget on the NewPatientSpecial landing page isn't passing the completed-booking event back to Google Ads. Ask: can we test the booking funnel end-to-end and verify the conversion tag is firing? This may also affect Smart Bidding by hiding a real conversion path.

Question 4 · Active Campaigns

"Search Emergency is at $859 CPA — can we restructure or pause?"

Launched in March, Search Emergency has spent $2,576 YTD for 3 conversions. The Emergency Extractions ad alone consumed $686 with zero conversions. Industry benchmark for emergency dental in Tier 1 markets is $40-100 CPA. Search Crowns is running similarly hot at $723 CPA, driven by informational keywords like "how much does a crown cost". Ask: what's the plan to rebuild these two campaigns around transactional intent, and what's the timeline?

Speaker notes · Slide 2

Set the tone. "I want to give WNDR the benefit of the doubt on each of these. There are reasonable explanations for some of them. But these are the four conversations I would have."
Question 1 (Brand): "Brand campaigns are nuanced. Existing patients calling because they searched the practice name are 'conversions' but not 'new patients.' WNDR may have intentionally paused to clean the numbers. Fair. But I'd want to know what trigger would turn it back on, because $9 CPA conversions — even half of those being existing patients — is still cheaper than letting competitors win that auction."
Question 2 (PMax): "This is the biggest reactivation opportunity. The old PMax was the best channel in the account. The policy issue is a known thing — superlatives without substantiation. A one-afternoon fix. I'd push for a joint working session on this."
Question 3 (Tracking): "This one's not about strategy. It's plumbing. A configured conversion action that has fired zero times in four months is almost certainly broken. Easy diagnostic, important fix because Smart Bidding optimizes against what it can see."
Question 4 (Emergency / Crowns): "I'm not saying turn these off. I'm saying the keyword list looks like it's matching the wrong intent. The Crowns campaign is paying for searches like 'how much does a crown cost' — research, not buying. Plan to rebuild."
Pivot to slide 3. "Now I want to talk about something bigger than tactical fixes. The audience targeting itself is a strategic choice that's worth a conversation, and I think there's significant upside."

03 / 03

The Audience · Strategic Opportunity

The agency is fishing in the smallest pond in Silicon Valley

Every audience attached to this account targets the top of the income distribution — "Avid Investors," "Affluent Audiences," "Cosmetic Professionals." There is real money in that pond. There is much more money in the pond next door if we change one thing in the offer.

Targeted Today

Top 5-10% by wealth signal

Performance Max asset groups target Tech Workers, Affluent Audiences, Recent Movers, Banking & Finance Avid Investors, Beauty/Wellness consumers. Premium positioning. Cash-pay audience that doesn't blink at $25K veneers.

The bet: high case value, low volume.

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Unlocked With Financing

Top 30-35% with monthly payments

Median Bay Area professional household income is roughly $180K. They cannot write a $25K check for veneers, but they can absolutely take $400/month financing for 60 months through Care Credit, Sunbit, or Cherry.

3-5x the addressable market, similar case value, requires copy and audience shifts only.

Current cosmetic ad copy (every ad)

"Experience A Dental Transformation"

"Renowned Cosmetic Dentist"

"Top Veneer Dentist Los Altos"

"Exclusive Smile Test Drive"

Financing mentioned in 0.5% of headlines

Test against this

"Veneers as low as $XXX / month"

"0% APR Financing Available"

"$0 Down Smile Makeover Plan"

"Care Credit & Sunbit Accepted"

Lead the headline. Don't bury it in callouts.

Speaker notes · Slide 3

Open with the framing. "This is the strategic conversation I think is worth having. It's not a fix — it's a positioning decision. And only you can make it."
Walk the targeting. "Every audience attached to this account is in the top 5-10% of household income. Tech Workers, Affluent, Banking and Finance Avid Investors, Beauty and Wellness premium consumers. That's a defensible cosmetic positioning. ClearChoice does this. High-end practices do this."
Name the trade-off. "But Bay Area has a massive professional audience making $150-220K who can't write a $25K check for veneers but can absolutely take $400 a month through Care Credit. That audience is not in the targeting today. They're in 'In-Market Dental Services' and they're searching cosmetic queries. They're being filtered out by audience signals."
Tie to the copy. "And the copy reinforces the premium-only positioning. Out of 3,232 headlines across all ads, 15 mention financing. Zero descriptions mention financing. The callout exists once at account level. For a $15-30K case, financing isn't garnish — it's the conversion lever."
Ask the doctor's question. "How do you want your practice positioned? Top 5% only — premium cash-pay, fewer cases, higher margin per case? Or top 30% — financing-accessible premium, more cases, slightly more volume in chairs? Both are defensible. They lead to different audience and copy choices."
Close with the small ask. "Even if you stay on premium positioning, two specific things are worth doing right now: (1) add a Customer Match list from your existing patient database so we exclude existing patients from new-patient prospecting and feed lookalikes from past cosmetic patients; (2) add one financing-led ad variant per cosmetic ad group as an A/B test. Both are cheap. Both unlock new data."
Wrap. "I'll send you the full audit with the YTD numbers. Mountain View pull is next. Happy to sit in on the WNDR call if it would help."