This is an anonymized version of a real audit, showcasing the depth of analysis PerfoAds provides.
Bright Smile Orthodontics · Austin, TX · Orthodontics & Dental Services
Your account scores 52/100: the core orthodontic and brand campaigns are well-structured and converting, but critical issues — 131 unanswered calls, 17 keywords with quality scores below 5, a 42% CPA increase while scaling, and $0 conversion values blinding Smart Bidding — mean nearly a third of your $6,877/month spend is underperforming or wasted.
Your Google Ads are bringing in around 475 patient leads over the last 3 months, which is solid. But there are some costly problems: about 60% of phone calls from your ads go unanswered, your landing pages are hurting your ad costs (Google charges you more because of slow or thin pages), and your ads don't track how much each type of lead is worth — so the system treats a high-value orthodontic consultation the same as a quick question. Fixing the call answering issue alone could recover dozens of missed patients each month. The good news: your brand searches perform excellently, and mobile — where most patients find you — is your strongest device.
Account generates 475 conversions at $43.44 CPA across 4 active Search campaigns with $20.6K total spend. Key issues: (1) QS avg 5.2 with 63% of keywords at QS 1-5, driven by Below Average Landing Page Experience on 13 keywords and Below Average Expected CTR on all 17 low-QS keywords — significant CPC inflation. (2) All 5 PRIMARY conversion actions have $0 value, making Smart Bidding blind to lead quality across 2 Maximize Conversions campaigns ($17.5K spend). (3) 'Calls from ads' uses Every counting, inflating conversion counts. (4) 60% missed call rate (131/218 calls) indicates major lead leakage. (5) Zero account-level negative keywords with 0 campaign negatives despite 827 in shared lists — $1,615 waste on non-converting terms. (6) CPA deteriorated 41.6% period-over-period (Jan 14–Feb 12 vs Dec 15–Jan 13) while spend nearly doubled. Brand campaign IS at 95.9% is excellent; non-brand IS ranges 63-73% with rank-loss dominant, pointing to QS as root cause.
Click a category to see related findings
Answer more phone calls — 131 missed calls are lost patients.
60% of ad-generated calls go unanswered, meaning you're paying to generate leads that never get a chance to book.
$2,000+/month in recovered patient value
Fix landing page speed and add pricing info.
Mobile speed scores 9/100 and 17 keywords have poor Quality Scores driven by landing page experience — you're paying a Google 'penalty tax' on every click.
15-30% lower cost per click ($300-600/month)
Add common misspelling keyword variants and fix ad typos.
25+ conversions come from common search variants you can't control bids on, and 4 ads have spelling errors including misspelling your own clinic name.
$100-150/month savings + improved trust
4
Campaigns
57
Ad Groups
72
Ads
46
Keywords
Get an AI-powered audit of your Google Ads account. Same depth of analysis, personalized for your business.
Get Your Audit© 2026 PerfoAds. This is an anonymized case study based on a real audit.