PMAX scales patient acquisition 89% across a multi-brand dental portfolio without adding budget.
THE EPIC WIN
Level identified that CHORD’s Google Search campaigns had reached local market capacity, and overcame the client’s quality concerns about PMAX by launching two tightly controlled brand tests, both of which delivered major conversion lifts within a single month, with budget held flat.
Conversion lift
89%
Cumberland (month-over-month)
Conversion lift
69%
Spark Orthodontics (MoM)
Cost per conversion
$5.55
Cumberland PMAX
Cost per conversion
$6.41
Spark Orthodontics PMAX
THE CHALLENGE
CHORD Specialty Dental Partners, a multi-location dental support organization (DSO), had built a strong Google Search foundation across its regional brand portfolio, including Cumberland Pediatric Dentistry and Orthodontics and Spark Orthodontics.
As available Search demand approached its ceiling in local markets, CHORD needed a way to reach new patients without opening the budget. Performance Max (PMAX) was the logical expansion channel, but not without a legitimate concern.
PMAX campaigns can over-index on top- and mid-funnel signals. They can appear highly efficient in-platform while failing to drive the actual booked appointments that practice operators track. For a DSO with multiple brands and location-level volume targets, a campaign that looked good in Google Ads but did not move consult numbers was not a solution. It was a risk.
THE ANALYSIS
The core question Level needed to answer before launching PMAX was not whether it could generate volume. It could. The question was whether CHORD’s existing account setup contained enough signal quality for PMAX’s automation to learn efficiently and stay anchored to appointment-generating conversions rather than soft engagement events.
THE INSIGHT
The hesitation about PMAX was reasonable, but it was based on a generalized concern rather than a CHORD-specific one. What the analysis clarified was that the quality risk was not inherent to PMAX; it was a function of how campaigns were configured and what signals were feeding the algorithm.
Getting that setup right before launch, rather than hoping for the best after, was the difference between a campaign that inflated conversion counts and one that drove patients through the door.
This shift, from optimizing for volume at the top of the funnel to optimizing for outcomes at the bottom, became the foundation of AIM’s V2 lead scoring strategy.
THE STRATEGY
Level launched PMAX for Cumberland Pediatric Dentistry and Orthodontics on January 2 and Spark Orthodontics on January 15. The launches were sequenced rather than simultaneous, allowing the team to monitor early signal quality from Cumberland before Spark went live.
- Conversion architecture: Offline conversion signal setup
- Campaign structure: Asset group structure across locations and service lines
- Launch sequencing: Sequenced launch to validate quality before scaling Cumberland launched January 2 as the first proof-of-concept. Spark followed January 15 once early performance confirmed the setup was working. This sequencing gave the team a read on conversion quality before committing a second brand.
- Budget discipline: Budget held flat across both accounts throughout the test period Conversion growth was not driven by additional spend. The same budget that had been supporting Search-only campaigns continued to support the expanded PMAX plus Search account structure. Efficiency improvements, not incremental investment, drove the results.
THE RESULTS
PMAX produced measurable results within its first full measurement period across both brands. The results were consistent in direction, which confirmed the approach was repeatable, not a single-account anomaly.
Total account conversions grew 89% at Cumberland and 69% at Spark, both within flat budget conditions. These gains were not a product of spending more. PMAX added access to demand that Search, at its capacity ceiling, could not reach, and the existing Search campaigns continued to run alongside it.
The PMAX CPLs ($5.55 and $6.41) confirmed that automation stayed efficient. The conversion growth confirmed that PMAX was not cannibalizing Search. And the 10% year-over-year increase in consult volume at both brands provided offline validation that the conversion growth was connecting to actual patient appointments, not just platform signals.
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