Gen4 Brand · Bay Area / Tier 1 Market · Managed by WNDR
YTD 2026 spend is $36,505 ($8,243/month, roughly half the daily-budget implied $16,959/month) producing 211 conversions at $173 blended CPA. The agency has paused most of the account's best-performing campaigns and is running the worst-performing ones at near-full budget. The paused older Performance Max delivered 69 conversions at $32 CPA (best in account). Paused Brand delivered $9 CPA. Paused Cosmetic LP #2 delivered $54 CPA. Meanwhile active Search Emergency runs at $859 CPA (8-20x benchmark) and active Search Crowns at $723 CPA.
38% of keyword spend ($6,716 of $17,562) is on zero-conversion keywords. One of four configured conversion actions (Book Appointment) has fired zero times YTD — the trigger is broken. Three Performance Max campaigns show "limited by policy" status that WNDR has not resolved. Account-level Optimization Score sits at 45-66% across campaigns (healthy is 75-90%). Quantified wasted spend YTD is approximately $9,000 of $36,505 (25%), without accounting for the paused-winners opportunity cost.
Jan 1 – May 13, 2026. All numbers from the Google Ads UI campaign / keyword / ad / asset-group reports.
The single most important finding in this audit. Each row below ranks YTD CPA. The agency's paused campaigns dominate the top of the performance ranking; the worst-performing campaigns are the ones actively running.
| Campaign | Status | Spend | Conv | CPA | CvR | IS | Verdict |
|---|---|---|---|---|---|---|---|
| Search Brand | PAUSED | $55 | 6.0 | $9 | 85.7% | 54% | Best CPA. Should be always-on. Paused. |
| Cosmetic LP #2 | PAUSED | $271 | 5.0 | $54 | 29.4% | 41% | Outperformed active Cosmetic campaign 9x. Paused. |
| Performance Max (older) | PAUSED | $2,224 | 69.0 | $32 | 12.7% | 24% | 69 conv at $32 CPA. Best PMax in account. Paused. |
| After Hours | PAUSED | $192 | 5.0 | $38 | 29.4% | 41% | Strong CPA. Paused. |
| Dentist Near Me | PAUSED | $400 | 3.0 | $133 | 27.3% | 50% | Above-benchmark CPA. Paused. |
| PMax General (active) | Enabled | $4,066 | 33.0 | $123 | 1.5% | 42% | Acceptable CPA but "limited by policy". |
| Search Sedation | Enabled | $1,786 | 10.0 | $179 | 20.8% | 71% | Best active campaign. Good CvR. |
| Search General | Enabled | $13,776 | 58.0 | $238 | 10.8% | 60% | 38% of spend. CPA borderline for Tier 1. |
| Search Cosmetic | Enabled | $6,096 | 12.0 | $508 | 12.2% | 80% | At top of cosmetic CPA range. CPC $62 very high. |
| Search Crowns | Enabled | $5,064 | 7.0 | $723 | 3.0% | 43% | Over-budget research-keyword campaign. |
| Search Emergency | Enabled | $2,576 | 3.0 | $859 | 8.3% | 74% | 8-20x benchmark. Worst-performing active campaign. |
| Bonding / Smile Makeover / Invisalign / PMax New | PAUSED | $0 | 0 | — | — | — | No spend, no ads, dormant. |
All four configured conversion actions are visible on every campaign's Goals field: [BOOK_APPOINTMENT/WEBSITE, CONTACT/WEBSITE, PHONE_CALL_LEAD/CALL_FROM_ADS, SUBMIT_LEAD_FORM/WEBSITE]. YTD performance shows the distribution.
| Conversion Action | Source | YTD Conv | % of Total | Status |
|---|---|---|---|---|
| Phone Call Lead | Call from Ads (call extension) | 588 | ~70% | Firing |
| Submit Lead Form | Website (NewPatientSpecial form) | 116 | ~14% | Firing |
| Contact | Website (likely contact-form or page event) | 220 | ~26% | Firing — verify what counts |
| Book Appointment | Website (booking widget) | 0 | 0% | Broken — fires zero |
Goal counts sum to more than reported total conversions (924 raw vs 211 deduped). Google deduplicates across actions for the same click. The percentages above reflect raw firing volume.
Of $17,562 in Search keyword spend YTD, $6,716 (38.2%) bought zero conversions across 76 keywords. An additional $2,693 went to 3 keywords with CPA above $400. Combined keyword waste: ~$9,400, or 53% of keyword spend. The Search Terms report (not yet pulled) will reveal whether these matched off-intent search queries; without it, the waste is partially attributable to the keyword choice itself.
| Keyword | Match | Campaign | Spend | Clicks | Impr |
|---|---|---|---|---|---|
| "cosmetic and restorative dentistry" | Phrase | Cosmetic | $448 | 3 | 128 |
| [dentist] | Exact | General | $379 | 5 | 284 |
| "cosmetic dentistry center" | Phrase | Cosmetic | $353 | 5 | 42 |
| "cosmetic dentistry cost" | Phrase | Cosmetic | $286 | 1 | 26 |
| "teeth reshaping" | Phrase | Cosmetic | $283 | 2 | 24 |
| "get veneers" | Phrase | Cosmetic | $274 | 6 | 78 |
| "local dentist" | Phrase | General | $242 | 11 | 177 |
| [veneers] | Exact | Cosmetic | $223 | 5 | 200 |
| "dentist veneers" | Phrase | Cosmetic | $206 | 4 | 188 |
| "urgent care dentist" | Phrase | Emergency | $188 | 2 | 15 |
| "teeth bonding" | Phrase | Cosmetic | $182 | 5 | 161 |
| "need tooth extracted" | Phrase | Emergency | $182 | 2 | 94 |
| "best cosmetic dentist" | Phrase | Cosmetic | $171 | 1 | 11 |
| [how much does a crown cost] | Exact | Crowns | $152 | 16 | 312 |
| [how much does a crown cost a dentist] | Exact | Crowns | $150 | 7 | 79 |
| Keyword | Match | Campaign | Spend | Conv | CPA |
|---|---|---|---|---|---|
| "dentist that does root canals" | Phrase | Emergency | $1,197 | 1 | $1,197 |
| "cosmetic dental care" | Phrase | Cosmetic | $915 | 1 | $915 |
| "dentist tooth crown teeth" | Phrase | Crowns | $581 | 1 | $581 |
| Keyword | Match | Campaign | Spend | Conv | CPA | CvR |
|---|---|---|---|---|---|---|
| [Peninsula Center of Cosmetic Dentistry] | Exact | Brand (paused) | $55 | 6.0 | $9 | 85.7% |
| "cosmetic dentist Los Altos" | Phrase | Cosmetic LP #2 (paused) | $16 | 3.0 | $5 | 75.0% |
| [find a dentist in your area] | Exact | Near Me (paused) | $303 | 3.0 | $101 | 42.9% |
| "dental doctor appointment" | Phrase | General | $232 | 3.0 | $77 | 75.0% |
| "dentist close to me" | Phrase | General | $585 | 3.0 | $195 | 16.7% |
| "see a dentist without insurance" | Phrase | General | $232 | 3.0 | $77 | 27.3% |
| "need a dentist" | Phrase | General | $827 | 3.0 | $276 | 7.5% |
The Performance Max | Cosmetic & General campaign was paused despite delivering 69 conversions at $32 CPA across 10 themed asset groups. The currently enabled PMax General is 3-asset-group, running at $117-146 CPA.
| Status | Asset Group | Campaign | Spend | Conv | CPA |
|---|---|---|---|---|---|
| PAUSED | General Dentist - Parents | PMax #1 | $263 | 13 | $20 |
| PAUSED | Cosmetic - Professionals | PMax #1 | $496 | 13 | $38 |
| PAUSED | Cosmetic Dentistry | Search Themes | PMax #1 | $351 | 13 | $27 |
| PAUSED | General Dentistry | Recent Movers | PMax #1 | $253 | 8 | $32 |
| PAUSED | General Dentistry | Tech Workers | PMax #1 | $378 | 8 | $47 |
| PAUSED | Cosmetic Dentistry | Tech Workers | PMax #1 | $109 | 4 | $27 |
| PAUSED | General Dentistry | Search Themes | PMax #1 | $73 | 4 | $18 |
| Enabled | Location Asset Group - New | PMax General (active) | $3,047 | 26 | $117 |
| Enabled | Location - Cosmetic | PMax General (active) | $1,019 | 7 | $146 |
The "limited by policy" status on the paused PMax #1 likely caused WNDR to pause it rather than fix the policy issues asset-group by asset-group. Reactivating PMax #1 after policy remediation is the single largest leverage point in this account.
All three Performance Max campaigns show "most asset groups limited by policy" in their status reasons. Bonding and Smile Makeover are paused with "No ads" status. None of these are fixed.
| Campaign | Status | Issue |
|---|---|---|
| PMax - General (enabled) | Eligible | Most asset groups limited by policy |
| Performance Max | Cosmetic & General (paused) | Paused | Most asset groups limited by policy |
| PMAX New (paused) | Paused | Most asset groups limited by policy |
| Bonding (paused) | Paused | No ads |
| Smile Makeover (paused) | Paused | No ads |
| Cosmetic Test LP | Ended | Campaign ended |
Likely policy triggers based on observed asset content: superlative claims ("Award-Winning", "Nationally Recognized", "Renowned"), before/after imagery, and personal-hardship-adjacent language. These appear in PMax asset group headlines and descriptions (e.g., "Nationally-Recognized Cosmetic Dentist In Los Altos" in the General asset group of PMax New).
Scores updated with performance data. Pillars 6 and 11 still N/A pending search terms and change history.
| # | Pillar | Score | Finding |
|---|---|---|---|
| 1 | Account Structure & Taxonomy | Critical | Best performers paused, worst performers active. Brand paused. Multiple abandoned PMax campaigns. |
| 2 | Conversion Tracking Integrity | Critical | 4 actions configured; Book Appointment fires 0. Contact firing 220 deserves verification. |
| 3 | Bid Strategy Fit | Needs Work | All campaigns Max Conv, no tCPA. 10+ months of data; ready for Target CPA on top campaigns. |
| 4 | Keyword Strategy & Match Type | Critical | 38% of keyword spend on zero-conv keywords. Crowns campaign loaded with informational queries. |
| 5 | Negative Keyword Hygiene | Strong | 6 shared lists, 3,300+ negatives. Best part of the account. |
| 6 | Search Terms (n-gram) | Need search terms YTD | Search terms report not yet pulled. |
| 7 | Audience Layering | Critical | No Customer Match. Two interest-based audiences. PMax has the audience signals; Search has nothing. |
| 8 | Ad Copy & Assets | Critical | Policy-trigger superlatives caused PMax disapprovals. Financing absent. 81% single-RSA ad groups. |
| 9 | Extension / Asset Coverage | Needs Work | Sitelinks + callouts well-covered. Some callouts use risky superlative language. |
| 10 | Geo, Schedule, Device | Critical | Desktop -100% on cosmetic campaigns. Presence-or-Interest leaking budget. |
| 11 | Change History / Cadence | Need change history YTD | Change history not yet pulled. Pause-pattern strongly suggests reactive management. |
Twelve Critical findings. Each tied to specific YTD numbers.
Performance ranking of YTD CPA (in order: best to worst): Brand $9 (paused), Cosmetic LP #2 $54 (paused), After Hours $38 (paused), PMax #1 $32 (paused), Dentist Near Me $133 (paused). The five top performers are all paused. Active Search Emergency runs at $859 CPA, Search Crowns at $723, Search Cosmetic at $508. The active set burns $13,736 YTD ($3,100/month) producing 22 conversions; the paused set delivered 88 conversions on $2,975 YTD before being paused. This single pattern is the highest-leverage finding in the audit.
PMax #1 delivered $32 blended CPA across 10 themed asset groups (best per-asset-group CPAs: $18-$47). It is paused with "most asset groups limited by policy" status reason. The currently enabled PMax General shows the same policy-limited status. Likely triggers: "Nationally-Recognized Cosmetic Dentist" headline in the New asset group, "Award-Winning Dental Office" across multiple groups, "Top Dentist" / "Top-Rated" copy. The policy issue is fixable. WNDR has not fixed it.
All campaigns list BOOK_APPOINTMENT/WEBSITE in their Goals field, yet across 211 total YTD conversions zero are categorized as Book Appointment. Phone Call Lead fires 588 times, Submit Lead Form 116, Contact 220. The NewPatientSpecial landing pages typically include a booking widget. Either the widget is missing the conversion tag, the trigger condition is incorrect, or the page that holds the booking widget is no longer the live URL. This is a tracking dead-end masking a meaningful conversion path.
76 of 105 spending keywords produced zero conversions. Worst by category: Cosmetic phrase keywords ("cosmetic and restorative dentistry" $448, "cosmetic dentistry center" $353, "cosmetic dentistry cost" $286, "teeth reshaping" $283, "get veneers" $274). Crowns campaign loaded with informational research queries ("how much does a crown cost" $152, "price for dental crown" $119, "crown for teeth" $114) that match research-stage intent, not buying intent.
YTD: $2,576 spent, 3 conversions. Benchmark CPA for emergency dentistry in Tier 1 markets is $40-100. The "Emergency - Root Canals" ad single-handedly consumed $1,260 for 1 conversion. The "Emergency - Extractions" ad spent $686 with zero conversions. Emergency CvR of 8.3% is at half the benchmark (15-30%). Either keyword targeting is wrong (informational "how to" queries), landing page is failing high-intent prospects, or both.
YTD: $5,064 spent, 7 conversions, 3% CvR. Crowns campaign loaded with informational keywords ("how much does a crown cost", "crown fell off tooth", "dental crown") which match research and post-treatment-emergency queries, not new-patient transactional intent. The CEREC same-day positioning is strong but the keyword list is fighting it.
YTD: $6,096 spent, 12 conversions, 12.2% CvR. Search Impression Share 79.6% (winning auctions). CPC $62 is at the high end of cosmetic CPC range. Top wasted keywords in this campaign: "[veneers]" exact-match $223 zero conv; "best cosmetic dentist" $171 zero conv (the ad copy cannot claim "best" without policy issue). Multiple "Veneers (General)" ads spent $956 with zero conversions.
When active (before being paused) Brand delivered 6 conversions on $55 spend across the 6 keywords ("Peninsula Center of Cosmetic Dentistry" + 3 doctor names: Marlana Shile, Joseph Field, Karl Supal). 85.7% conv rate, 24.14% CTR, 54.29% IS. This is the most efficient channel in the account. It is off. Every patient currently searching the practice or doctor by name is reaching organic or paid competitor results.
Search Cosmetic has 79.6% IS at $62 CPC with desktop modifier -100%. For a Tier 1 Bay Area cosmetic prospect researching veneers at $15K-30K, desktop is 30-40% of the addressable audience. The agency has eliminated that audience. Combined with the high CPC and high IS, this suggests the campaign is paying premium mobile prices because desktop is unavailable.
Zero Customer Match lists uploaded. Two attached audiences are interest-based with no relevance to the YTD conversions. The active PMax has audience signals but no Customer Match seeds, so its lookalikes are weaker than they could be. The paused PMax #1 had two audience signal attachments but still no Customer Match. For a cosmetic practice running for 4+ years, the patient list is the most valuable unused asset.
15 of 3,232 headlines (0.5%) and 0 of 857 descriptions mention financing. One callout "Flexible Financing" exists at account level. Bay Area cosmetic patients researching $15K-30K veneer cases consistently rank financing as their top conversion concern. The current ad set leads with "Smile Test Drive" and "Free Virtual Consultations" — valuable but financing is the second click that wasn't there.
Zero implant keywords. Zero All-on-4 / full-arch / teeth-in-a-day keywords. Structured snippet includes "Implants & Dentures" so the practice represents itself as offering implants. Single-implant searches in Los Altos run $25-60 CPC with case values $3,500-6,500. Full-arch (if offered) runs $50-120 CPC with case values $25K-50K per arch. The single highest-value paid search segment in dental is entirely uncovered.
Google's own optimization score per campaign: Cosmetic 46.8%, Crowns 45.7%, Emergency 45.2%, General 46.5%, Sedation 53.0%, PMax General 66.0%. Healthy is 75-90%. The score aggregates recommendations Google believes the account is leaving on the table. Most recommendations are reasonable; some (auto-apply theme broadening) should be reviewed manually before adopting.
Daily-budget allocation across enabled campaigns is $557.87 ($16,959/month). YTD actual spend is $8,243/month, just 49% of allocated. This is consistent with Max Conversions throttling itself due to data sparsity and policy-limited PMax serving. Effectively, half of the budget is sitting unused because the bid strategy can't find enough conversions to deploy it.
Confirmed from Editor export: Bonding, Smile Makeover, Dentist Near Me, Brand, After Hours, Crowns, Cosmetic-LP #2, both Test LPs, the older PMax all use "Location of presence or Area of interest." For a local practice, this leaks budget to people researching the area but not in it.
All 11 enabled campaigns on Max Conversions with target_cpa = $0. For campaigns with 30+ conversions/month (Search General is the only one approaching this), Target CPA is the next-level discipline. The current Max Conversions setting produces erratic spend deployment.
149 of 184 ad groups have one RSA only. Industry best practice is 2-3 RSAs per ad group for test surface. Particularly relevant for cosmetic ad groups where financing-led vs outcome-led testing would matter most.
Callouts include "Award-Winning Team", "Nationally-Recognized", "World-Class Dentists", "Renowned Cosmetic Dentist", "Renowned Office". Headlines include similar at 4.2% frequency. Same language likely caused the PMax policy limitations. Will catch up to the Search ads if it hasn't already.
25 ads point to /smilemakeover-losaltos2 covering Bonding, Veneers, Cosmetic Dentist, and Smile Makeover ad groups. The Bonding searcher (~$500-1,500 case) and the Veneers searcher (~$15K-30K case) need different content. Crowns ads have higher-spending ads pointing to a Crowns LP but the keyword set is wrong for that LP.
The currently enabled PMax General has 3 asset groups with zero video assets. Search themes include placeholder text like "dentist in GEO" and "best dentist in GEO" never substituted with Los Altos. The paused PMax #1 had 3 videos per asset group — assets exist, they weren't migrated.
Six shared lists totaling 3,300+ negatives applied across 11 campaigns. Plus 140 PMax placement exclusions. This is the labor-intensive part of dental Google Ads and WNDR has done it. Maintain this work product through any management change.
10 themed asset groups by audience (Tech Workers, Parents, Recent Movers, Affluent, Beauty/Wellness, Professionals) is correct PMax architecture. Each delivered $18-$47 CPA. Once policy issues are resolved, this campaign is the account's strongest reactivation candidate.
Distinct campaigns for Cosmetic, Crowns, Sedation, Emergency, plus paused Bonding / Invisalign / Smile Makeover. Better segmentation than typical dental agency. Foundation is sound; settings and content are the issues.
Sorted by impact/effort. Items 1-5 are this-week fixes that could reasonably double current conversion volume at lower CPA.
| # | Action | Effort | Impact | Estimated Lift |
|---|---|---|---|---|
| 1 | Reactivate Brand campaign. Switch to Target Impression Share 95%+. | Low | High | +6-12 conv/month at $9-15 CPA |
| 2 | Reactivate Cosmetic LP #2 campaign. | Low | High | +5-10 conv/month at $54 CPA |
| 3 | Fix the Book Appointment conversion trigger on NewPatientSpecial booking pages. | Low | High | Visibility into booking funnel; correct bid optimization |
| 4 | Pause the Search Emergency "Extractions" ad ($686 zero-conv) and pause the highest-spend zero-conv keywords ($448 + $353 + $286 + $283 + $274 = $1,644 immediate savings). | Low | High | $1,600+/quarter saved |
| 5 | Set location targeting to "Presence" only across all campaigns. | Low | Med | 5-15% click-quality lift |
| 6 | Remove -100% desktop bid modifier across cosmetic-relevant campaigns. | Low | Med | 30-40% audience expansion on cosmetic |
| 7 | Resolve PMax #1 policy limitations (replace superlative language, resubmit). Reactivate PMax #1, pause underperforming active PMax General. | Med | High | +50-70 conv/month at $30-50 CPA |
| 8 | Rebuild Crowns keyword list around transactional intent. Drop informational queries. | Med | Med | $1,500+/quarter reallocated |
| 9 | Add financing-led RSA to every cosmetic ad group. Update callout extensions. | Med | Med | 20-40% lift on cosmetic CvR |
| 10 | Replace superlative claims ("Award-Winning", "Renowned", "World-Class") in callouts and headlines. | Med | Med | Policy resilience, fewer disapprovals |
| 11 | Reactivate Dentist Near Me and After Hours campaigns. | Low | Med | +8-15 conv/month at $40-130 CPA |
| 12 | Upload Customer Match lists. Attach to PMax as audience signals; use as Observation on Search. | High | High | 15-30% PMax CPA improvement |
| 13 | Switch high-volume campaigns to Target CPA after 30 days of cleaner data. | Med | Med | 10-20% CPA discipline |
| 14 | Launch dedicated Implants campaign. Confirm Full-Arch scope and launch if offered. | High | High | New revenue stream, $400-1,200 CPB |
| 15 | Set up Offline Conversion Import (booked-and-treated cases back to Google Ads). | High | High | True CPB measurement; Smart Bidding optimizes to revenue |
| 16 | Build dedicated Veneers and Bonding landing pages. | High | Med | 15-30% CvR lift on cosmetic |
| 17 | Pull Search Terms YTD; complete n-gram waste analysis and add corresponding negatives. | Low | Med | Quantified ongoing waste removal |
| Missing | What it would unlock |
|---|---|
| Search Terms Report (YTD) | N-gram analysis: exactly which queries triggered the zero-conv keywords. Specific negative recommendations. Verification that the "[veneers]" exact-match wasn't actually matching close-variants. |
| Change History (YTD) | When and why the agency paused each winner. Frequency of meaningful changes. Cadence grade for WNDR. |
| Conversions Summary | Verification of attribution model, click-through window, Enhanced Conversions status, and the specific definition of "Contact" (which fires 220 times YTD). |
| Auction Insights | Competitor landscape in Los Altos / Bay Area cosmetic. Whose share is being lost to whom. |
| Mountain View account data | Same audit framework applied to PCCD-MV ($9.3K/month). MV likely mirrors many of the same findings given common agency, common naming convention, and shared negative lists. |
inputs/google-ads/PCCD-LAL/