Q2 2026 State Benchmark Report: Overhead, Staffing, PPO, and Valuation Data
State-by-state dental practice benchmarks for Q2 2026. Overhead, staffing costs, PPO write-offs, and valuation multiples across the top 10 markets.
The median dental hygienist now earns $98,100 a year, according to the U.S. Bureau of Labor Statistics, and 87.7% of dentists who tried to recruit one in Q2 2026 rated it "very" or "extremely" challenging, per the ADA Health Policy Institute. That is the cost side. On the revenue side, the same ADA report shows that since January 2021, staff hourly earnings and dental equipment and supply prices each rose 23% while the provider reimbursement rate index, averaged across all payer types, rose 19%, against 27% cumulative inflation (pp. 17-18).
Four points of gap, held open for five years, is not a bad quarter. Our view: overhead percentage is the least useful number in this report, and a single-location general practice carrying six PPO contracts on fee schedules it hasn't challenged since 2021 is no longer a sound asset. It needs repricing this year, not a tighter supply budget. A fee schedule that hasn't moved since 2021 isn't a contract, it's a standing order for an annual pay cut.
Costs Rose 23%. Reimbursement Rose 19%. Inflation Rose 27%.
Read those three numbers together, because separately each one is survivable and together they describe a vise. Your two largest controllable categories, people and materials, tracked each other almost exactly at 23%. Your fee schedules lagged four points behind them. And the broader economy your landlord, your lender and your associate candidates live in ran 27%, which means your own purchasing power fell even where you kept pace with your clinic's costs.
This is the distinction we call Drift vs. Erosion. Drift is small, steady, recoverable, and you manage it operationally: a supply category creeping up 2%, a lab bill you renegotiate, an overtime pattern you schedule away. Erosion is structural and compounding, and it only responds to renegotiation, repricing or exit. A reimbursement index running four points behind your input costs for five consecutive years is erosion. Owners who treat it as drift respond with supply audits and staff meetings about gloves, and they lose anyway, slowly, while feeling productive.
One more thing about benchmarks: the numbers that travel nationally are the ones above. The two numbers that actually decide your year are local, and nobody publishes them for your ZIP code. They are what a hygienist costs within a 20-minute drive of your front door, and what your top three plans pay for a crown. Get those two right and the national report is background reading.
Hygiene Is a $98,100 Line Item You Can't Reliably Fill
A full-time hygienist at the national median costs $98,100 in wages before payroll taxes, benefits, or the premium you'll pay over median in a competitive market. Dental assistants run a median of $48,070, with the 10th percentile at $37,130 and the 90th at $62,250, per the Bureau of Labor Statistics. That assistant spread is the one to notice: $25,120 separates the bottom decile from the top. In a tight market you are not choosing where to sit on that curve. The market is choosing for you, and it is choosing the top half.
The 87.7% recruiting difficulty figure changes the strategic logic of everything else in this report, and most owners read it backward. They read it as a reason to be defensive: hold every patient, keep every plan, because you can't staff growth anyway. The correct reading is the opposite. When chair hours are the scarce input and you cannot buy more of them at any reasonable price, the lowest-paying slice of your payer mix stops being a patient base and becomes a queue you are subsidizing with capacity you can't replace.
