Dental Practice Overhead Benchmarks in Maryland (2026)

A general dentist in Maryland who owns nothing, signs no lease and makes no payroll earns a mean of $234,670 a year, per the U.S. Bureau of Labor Statistics OEWS Maryland estimates (2,970 general dentists, median hourly wage $87.50). Run a million-dollar Maryland practice at the national median overhead ratio and you take home $231,000. You signed the lease, guaranteed the loan, hired eleven people and carried the malpractice tail to earn $3,670 less than the dentist working four days a week for someone else.

Our view: overhead percentage is the wrong number for a Maryland owner to manage. The state's practices don't have an expense problem, they have a production-per-chair problem, and every hour spent renegotiating a supply contract instead of repricing a payer contract makes it worse. That is a thesis an informed owner can argue with, and plenty will. Here's the defense.

$231,000 Is What a Million-Dollar Practice Actually Pays You

Start with the ratio everyone quotes. The ADA Health Policy Institute puts median annual practice expenses for GP owners at $615,000 against $800,000 in revenue for the 2019 to 2023 pooled period. That is a 76.9% overhead ratio. The same series for 2014 to 2018 shows $576,382 in expenses against $772,258 in revenue, or 74.6%. Five years, 2.3 points of ratio gone.

Apply 76.9% to a Maryland practice collecting $1,000,000 and you get $769,000 of expenses and $231,000 of owner earnings before debt service. If you carry an acquisition or buildout note at $8,000 a month, that is another $96,000 and you are at $135,000. At the Maryland median hourly wage of $87.50, an associate working 32 clinical hours a week for 46 weeks bills out $128,800 of chair time. You are running the whole enterprise for roughly what your own hands are worth on the open market.

That is the arithmetic every Maryland owner should have taped inside a cabinet door. Ownership in this state currently pays a premium of approximately nothing, and the premium is still falling.

The 3.1-Point Gap Is Erosion, Not Drift

The ADA figures include the number that actually matters, and almost nobody quotes it: expenses are growing 6.7% a year while revenue grows 3.6%, which has already produced a 6.3% decline in net income. A 3.1-point annual spread is not a bad quarter. It compounds.

Run the ADA medians forward five years at those rates. Year one: $828,800 of revenue against $656,205 of expenses, net $172,595. Year three: $889,548 against $747,082, net $142,466. Year five: $954,748 of revenue against $850,542 of expenses, net $104,206. Top line up 19% and owner income down 44%, with nothing going wrong that a busy owner would notice in any single month.

This is the distinction we call Drift vs. Erosion. Drift is small, steady and recoverable: your supply spend creeps up 40 basis points because the assistant started ordering the nicer bur blocks, and you fix it with a purchasing policy. Erosion is structural and compounding: the input you buy most of is rising at nearly twice the rate of the price you're allowed to charge, and no amount of operational discipline closes a gap that wide. A 3.1-point annual spread between expense growth and revenue growth is erosion. It requires renegotiation, repricing or exit, and treating it as drift is the expensive mistake.

Maryland makes this sharper than most states because the wage line is set by a labor market that includes Baltimore, the Washington suburbs and two of the wealthiest counties in the country. Your hygienists and assistants are priced against hospital systems and federal contractors. Your fee schedule is not.

What Most Owners Get Wrong: Cutting Supplies to Fix a Wage Problem

The specific mistake, and it is made most often by owners of four to six operatory general practices in the Baltimore and Washington suburbs who ran flat out through the 2021 to 2023 wage escalation and never touched their fee schedule: attacking the small lines because the small lines are the ones you control alone.

Look at where the money actually sits. Private Practice Research reports that in a healthy GP solo practice, total staff cost typically runs 25% to 30% of collections, while lab fees, occupancy and supplies each typically land in the 5% to 10% range. Staff is the mountain. Everything else is foothills.

So run the cut. Say supplies are 8% of a $1,000,000 practice, $80,000, and you go to war on it: new vendor, formulary discipline, no more convenience ordering. A very good year gets you 20% off, which is 1.6 points of collections, or $16,000. Now compare that to the erosion gap. At 3.1 points a year on the same $1,000,000, the spread costs you $31,000 in year one alone. Your best supply year in a decade bought you about six months of standing still.

Meanwhile, a two-point improvement in the staff line on the same practice is $20,000, and a 4% fee increase on the 40% of production that isn't rate-capped is $16,000 of pure margin. Same effort, different line, and the second one recurs every year.

The tell that you're making this mistake: you know your supply cost per month to the dollar and you can't say what percentage of your production is paid at a schedule you last negotiated before 2022.

Five Operatories at $200,000 Each

Scale changes what overhead means. According to the Practice Market Index, our own dataset built from dental practice broker listings, the median practice on the market has 5 operatories (middle half 4 to 7, n=754) and collects a median of $200,000 per operatory (middle half $146,875 to $268,708, n=643). These describe the asking side of the market, the practices currently listed, not the typical practice in the country. But they map the ground a buyer or a benchmarker is walking on.

Maryland listings skew larger. Median collections among Maryland practices listed for sale run $1,041,338 (middle half $676,000 to $1,583,000, n=25), against $957,588 nationally (n=753). The $1,000,000 practice in the scenario above sits almost exactly at the middle of the Maryland listing distribution.

Here is why per-operatory production is the number we'd manage instead of overhead percentage. Fixed cost does not care how much you produce in a room. Occupancy at 5% to 10% of collections is really a fixed rent divided by whatever you collect. A five-operatory Maryland practice collecting $700,000 is doing $140,000 a room; the same building, the same sterilization center, the same front desk at $1,100,000 is doing $220,000 a room. The second practice will show a dramatically better overhead ratio without having cut a single expense. Overhead percentage is mostly a readout of your denominator.

The Medicaid Recall Chair Runs at 61% Staff Cost

Payer mix is where Maryland overhead is actually decided, and the state publishes the numbers. The Maryland Medicaid Dental Fee Schedule (CDT 2025) reimburses D1110, adult prophylaxis, at $67.12, and D0120, periodic oral evaluation, at $31.81. A standard adult recall visit collects $98.93.

Say you pay a hygienist $50 an hour and carry roughly 20% in payroll taxes and benefits, so a clinical hour costs $60 in direct wage. If total staff cost should run 25% to 30% of collections, then an hour of hygiene that costs $60 needs to collect $200 to $240 to hit the benchmark. That recall visit collects $98.93, which puts the staff cost on that hour at 61%.

Run eight of those hours a day, four days a week, 46 weeks, and that column collects $145,633 against $88,320 of direct hygiene wage, before rent, sterilization, instruments, the assistant who seats the patient or the front desk that chases the eligibility. There is not a purchasing policy in the world that fixes this. It is a contract problem, and it is erosion, not drift.

We are not telling you to drop Maryland Medicaid. Access matters, the Healthy Smiles population is real, and for some practices the child codes and the volume work. We are telling you to stop calling it an overhead problem. If a payer pays $98.93 for an hour that costs $60 in wage alone, you either compress the appointment, restructure it with assisted hygiene, cap that book as a fixed percentage of your schedule, or you stop taking it. Those are the four options. Cutting gloves is not a fifth.

The $560 That Isn't Your Problem

For contrast, consider what owners in this state do sweat. The Maryland Board of Dental Examiners fee schedule sets license renewal at $560, with a $300 late fee for renewals filed between July 1 and 31. Miss the window and you are out $860.

That is 2.8% of what the expense-to-revenue gap costs a $1,000,000 practice in a single year. Pay it on time, obviously. But notice how much easier it is to feel a discrete $300 penalty than a $31,000 structural spread that arrives as nothing at all, distributed across twelve payrolls and invisible in every one of them. Erosion is quiet. That's the whole danger.

Three Numbers to Pull Before Friday

Pull your total staff cost including taxes and benefits as a percentage of last twelve months' collections, and see how far above 30% you are. Then pull collections per operatory and compare it to the $200,000 median on the listing side of the market. Then pull the percentage of your production paid at a contracted rate you have not renegotiated since 2022, and put a date on the calendar to send those requests. If the answer to number one is above 34% and number three is above half your production, you are not managing a cost problem, you are managing a price problem, and it will not wait another year.

We publish a free overhead benchmarking calculator that breaks your practice into staff, lab, occupancy, supplies and everything else, then shows you which lines are drift and which are erosion against the ADA and Maryland figures above. It takes about four minutes with a P&L open. Run your own numbers, and tell us where your staff line landed. What we're tracking next: whether the Maryland Medicaid schedule moves with the next CDT update, and whether the listing-side collections median keeps climbing. What would change our mind: four straight quarters of flat wage growth in dental support roles. If that happens, the 3.1-point gap becomes drift, the operational fix starts working again, and this argument loses its teeth. We don't expect it.