Ivanov Orthodontics is a high-end orthodontic practice in North Miami that recently
expanded with a new Miami Lakes office. Braces and Invisalign are a one-time,
high-ticket decision, which makes paid search unusually competitive and unusually
expensive to get wrong.
Ad spend managed$5,000 / month
EngagementMay 2025 → Present
LocationsNorth Miami + Miami Lakes
ChannelGoogle Ads (Search)
Ivanov Orthodontics, 5.0★ across 721 reviews
02 / The Problem
The channel was losing money on every dollar.
$42,000
Google Ads spend
$23,000
New patient revenue
ROAS
0.55x
Net position
−$19,000
Nearly $19,000 was lost upfront, making the channel cash-negative and fundamentally unsustainable.
03 / Diagnosis
Three things were quietly breaking the account.
01
Spend aimed at the wrong searches
Most budget was flowing toward competitor brand terms, insurance-related searches Ivanov Ortho does not accept, and low-intent modifiers.
Success was counted as a click on the call button, not an actual phone call, and not a call lasting over 60 seconds. Lead quality and real demand were invisible.
✕ Click on call button counted
✕ Call connected ignored
✕ Call > 60 seconds ignored
✕ Booked appointment ignored
03
A high-ticket, one-time purchase
Braces are bought once in a lifetime. The upfront ticket is high, competition is fierce, and a previous agency had left crucial steps missing from the cost-per-booking equation.
June 2025, pre-takeover. 105 booked appointments, but only a 25% show rate, and $23,374 in first-appointment charges against $42,000 spent.
04 / Actions Taken
We rebuilt it from the keyword up.
01
Negative keywords, industrialised.
We started with the negative keyword list. Every wasted query became a permanent exclusion: competitor brands, insurance terms, price-shoppers, job seekers.
from 200
2,064
negative keywords to date
02
Conversion tracking, rebuilt on reality.
We replaced button-click conversions with real outcomes imported from Liine: new patient booked calls and existing patient booked calls, both set as primary actions.
✓ New Patient Booked Call primary
✓ Existing Patient Booked Call primary
✓ Calls over 60 seconds tracked
✓ Imported from clicks server-side
03
A 6km radius, not a whole county.
Both locations serve large areas, so we tightened targeting to a 6km radius per office. Tighter geography means shorter drives, and a show-up rate above 90%.
6 kmper location
04
Show-up rate as the real KPI.
A booked appointment that never arrives is not a conversion. We optimised the whole account toward attendance, pushing show-up rates above industry standards across both Ivanov Ortho and Urbn Dental.
90%+
show-up rate
05 / Results Achieved
46% cheaper. 77% more. On 5% less spend.
Previous agency
Spend$60,000
Booked appointments137
Cost per booked appt$438
vs
Our work · May 2025 → Present
Spend$57,052
Booked appointments242
Cost per booked appt$236
−46%
Cost per booked appointment
+77%
Booked appointments
−5%
Total ad spend
242
Appointments booked
New patient leads & booked appointments
By quarter · Ivanov Orthodontics
New patient leadsBooked appts.Conversion rate
We took over the account in May 2025. Conversion rate climbed from 36% to a peak of 76%.
Rolling 30-day average of new patient leads and booked appointments: the trend line under our management.
A channel that lost $19,000 upfront now books appointments at $236, and books 77% more of them.
Ivanov Orthodontics · North Miami & Miami Lakes
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