Three sample budgets from the Alithos planning model: a 4-operatory leased office at standard finish comes to about $784,800 (range $746K to $824K). A 6-operatory leased premium office with CBCT is about $1,350,680. A 6-operatory ground-up build at standard finish is about $1,579,960 before land. Fully financed at 8.25% over 15 years, that is roughly $7,614, $13,103 and $15,328 a month in debt service.
If you want the general question answered (what it costs to open a practice, by category and path), start with the dental practice startup costs guide. This post does something narrower. It shows three complete budgets, every line filled in, so you can see how the numbers fit together and where yours will differ.
These are planning math from the Alithos estimator, not quotes, bids or survey data. Every line comes from a stated assumption, shown in each table. The ranges are plus or minus 5%. The full grid of scenarios is on the 2026 cost benchmark [1].
Budget 1: what does a 4-operatory leased startup cost?
About $784,800 in the model, with a planning range of $745,560 to $824,040. It models a lean single-doctor startup: one doctor, a hygienist, four operatories, a second-generation or shell suite in a retail or medical building, standard finishes, and sensors plus a panoramic unit rather than a CBCT.
| Line | Model assumption | Amount | Share |
|---|---|---|---|
| Space | 4 ops × 500 sq ft | 2,000 sq ft | n/a |
| Construction (lease finish-out) | $170/sq ft, standard | $340,000 | 43.3% |
| Dental equipment | $42,000 per op | $168,000 | 21.4% |
| Imaging | Sensors + pano | $60,000 | 7.6% |
| Cabinetry | 10% of construction | $34,000 | 4.3% |
| IT + furniture | $45,000 + $3,000 per op | $57,000 | 7.3% |
| Soft costs | 12% of construction | $40,800 | 5.2% |
| Working capital | Model default | $85,000 | 10.8% |
| Total | Range ±5%: $746K–$824K | $784,800 | 100% |
Two things stand out. Construction is the biggest single line, and the three lines that scale with it (construction, cabinetry and soft costs) add up to $414,800, more than half the total. And working capital is over a tenth of the budget. People who leave it out are not trimming fat; they are skipping a line the practice needs in its first months.
For a reality check against published figures: an ADA News expert column says opening a practice often takes $500,000 at minimum [2]. A 2026 dental-lawyer guide puts equipment for a standard build at $100,000 to $200,000 and leasehold build-outs at $150 to $350 per square foot [3]. The model's $168,000 and $170 per square foot sit inside both.
Budget 2: what does a 6-operatory premium office with CBCT cost?
About $1,350,680, with a range of $1,283,146 to $1,418,214. This is a larger leased office for a doctor who expects to add a second hygienist or an associate, with premium finishes, premium chairs and delivery, and a CBCT for implant and surgical work.
| Line | Model assumption | Amount | Share |
|---|---|---|---|
| Space | 6 ops × 450 sq ft | 2,700 sq ft | n/a |
| Construction (lease finish-out) | $220/sq ft, premium | $594,000 | 44.0% |
| Dental equipment | $58,000 per op | $348,000 | 25.8% |
| Imaging | Sensors + pano + CBCT | $130,000 | 9.6% |
| Cabinetry | 10% of construction | $59,400 | 4.4% |
| IT + furniture | $45,000 + $3,000 per op | $63,000 | 4.7% |
| Soft costs | 12% of construction | $71,280 | 5.3% |
| Working capital | Model default | $85,000 | 6.3% |
| Total | Range ±5%: $1,283K–$1,418K | $1,350,680 | 100% |
Note the space line. The model assumes 450 square feet per operatory at 6 to 7 ops instead of 500, because shared rooms (sterilization, lab, front desk, break room) get spread across more chairs. So 50% more operatories needs only 35% more space.
Equipment and imaging together are $478,000 here, about 35% of the budget. That is where finish level shows up fastest. Whether a CBCT belongs in your first budget is its own decision; I walk through it in CBCT or not.
Budget 3: what does a 6-operatory ground-up build cost?
About $1,579,960, with a range of $1,500,962 to $1,658,958, and that is before you buy land. Same six operatories and 2,700 square feet as Budget 2, but at standard finish with sensors and a pano. The difference is that you are paying for the building, not just the inside of a suite.
| Line | Model assumption | Amount | Share |
|---|---|---|---|
| Space | 6 ops × 450 sq ft | 2,700 sq ft | n/a |
| Construction (ground-up) | $340/sq ft, standard | $918,000 | 58.1% |
| Dental equipment | $42,000 per op | $252,000 | 15.9% |
| Imaging | Sensors + pano | $60,000 | 3.8% |
| Cabinetry | 10% of construction | $91,800 | 5.8% |
| IT + furniture | $45,000 + $3,000 per op | $63,000 | 4.0% |
| Soft costs | 12% of construction | $110,160 | 7.0% |
| Working capital | Model default | $85,000 | 5.4% |
| Land | Excluded | Not included | n/a |
| Total | Range ±5%: $1,501K–$1,659K | $1,579,960 | 100% |
Construction-driven lines are now $1,119,960, about 71% of the total. One caution on the rate: a 2026 dental-lawyer guide puts ground-up dental construction at often $400 or more per square foot [3], so the model's $340 standard rate is on the conservative side. Your market may run higher. Ask any contractor whether site work, utility connections and impact fees are inside their per-square-foot number before you compare it with this one. The tradeoffs between paths are covered in build, lease or condo and the guide to building a dental office.
What changes between the three budgets?
| Line | Budget 1 4 ops, lease, standard | Budget 2 6 ops, lease, premium + CBCT | Budget 3 6 ops, ground-up, standard |
|---|---|---|---|
| Square feet | 2,000 | 2,700 | 2,700 |
| Construction | $340,000 | $594,000 | $918,000 |
| Equipment | $168,000 | $348,000 | $252,000 |
| Imaging | $60,000 | $130,000 | $60,000 |
| Cabinetry | $34,000 | $59,400 | $91,800 |
| IT + furniture | $57,000 | $63,000 | $63,000 |
| Soft costs | $40,800 | $71,280 | $110,160 |
| Working capital | $85,000 | $85,000 | $85,000 |
| Total | $784,800 | $1,350,680 | $1,579,960 |
| Per operatory | $196,200 | $225,113 | $263,327 |
| Per square foot, all-in | $392 | $500 | $585 |
Three inputs move these totals far more than anything else:
- Path (lease or ground-up). Same 6 ops at standard finish: $1,019,980 leased versus $1,579,960 ground-up. That is about $560,000, and it comes almost entirely from construction and the lines tied to it.
- Finish level and CBCT. Same 6 leased ops: $1,019,980 at standard versus $1,350,680 at premium with CBCT, a $330,700 step. The CBCT package alone is $70,000 of that.
- Operatory count. Going from 4 to 6 leased ops at standard finish adds $235,180, from $784,800 to $1,019,980. Each op brings equipment, space and the construction that space needs.
Working capital and the base IT line barely move. That is why working capital is 10.8% of Budget 1 but only 5.4% of Budget 3.
What is not in these sample budgets?
A sample budget only covers the lines in its model. These are the big ones it leaves out:
- Land for Budget 3. Price, closing costs and any site work the contractor excludes.
- Rent during build-out for Budgets 1 and 2, unless your lease gives you free rent while you build. Read the lease, and have your attorney review it before you sign.
- Pre-opening payroll and training. Your team usually starts before the first patient does.
- Pre-opening marketing, signage approvals and the website.
- Your personal living costs while the practice ramps, which a lender looks at too.
- A separate contingency. The ±5% range is a planning band, not a contingency reserve.
The full list of lines that get missed, and how to budget each one, is in the hidden costs that ambush dental office projects. Working capital, which the samples do include, gets its own treatment in working capital: the budget line that decides whether you sleep.
What monthly payment do these budgets imply?
The estimator assumes the full total is financed over 15 years at 8.25%. That rate is an assumption, not a quote. It sits between the bank prime rate of 7.00% on the Federal Reserve's H.15 release for October 29, 2026 [5] and about 10.0%, the SBA's maximum variable rate on a 7(a) loan over $350,000 at that prime (prime plus 3.0%) [6].
| Budget | 15 yr at 7.00% | 15 yr at 8.25% (model) | 15 yr at 10.00% | 10 yr at 8.25% |
|---|---|---|---|---|
| 1: $784,800 | $7,054 | $7,614 | $8,434 | $9,626 |
| 2: $1,350,680 | $12,140 | $13,103 | $14,514 | $16,566 |
| 3: $1,579,960 | $14,201 | $15,328 | $16,978 | $19,379 |
Standard amortization, fully financed, rounded to the dollar. The 10-year column matters because SBA 7(a) maturities are generally up to 10 years for equipment and working capital and up to 25 years for real estate [6], so a real loan structure can blend terms. If you borrow through SBA 7(a), a startup generally needs to inject at least 10% of project cost as equity, which lowers the amount financed [7]. Some dental lenders, such as Bank of America Practice Solutions, advertise up to 100% project financing for startups, subject to credit approval [9]. Run your own amount, rate and term in the dental loan payment calculator, and see the dental practice financing guide for how these loans are put together.
Do they pass the lender's 1.25x test?
That depends on your projected cash flow, not the budget. Many dental lenders look for a debt-service coverage ratio of at least 1.25, as a guideline rather than a strict minimum [4]. In plain terms: cash flow available for debt service should be at least 1.25 times the annual loan payments.
| Budget | Annual debt service (8.25%, 15 yr) | Cash flow needed at 1.25x |
|---|---|---|
| 1: 4 ops, lease, standard | $91,364 | $114,205 |
| 2: 6 ops, lease, premium + CBCT | $157,242 | $196,552 |
| 3: 6 ops, ground-up, standard | $183,934 | $229,917 |
That last column is the cash flow needed to cover this loan alone. Lenders often run a global test that also counts your personal debts and living costs, so the real bar is higher. Budgets 1 and 2 also pay rent out of that same cash flow. Budget 3 pays no rent, but it takes on property taxes, insurance and upkeep. Test your own projection with the DSCR calculator, and read what lenders want to see before you apply.
How do you adapt a sample budget to your project?
- Start from production, not space. Decide how many operatories your schedule needs in year one and year five. How much space you need walks through it.
- Pick the path honestly. Lease, condo or ground-up changes the construction rate more than any finish choice. Compare them in the planning options guide.
- Replace the construction rate with local evidence. Use real numbers for your market and your suite. Construction cost per square foot explains what is inside a quote and what is not.
- Price equipment and imaging from line items. Get quotes against the same list from more than one source, and decide on CBCT on purpose.
- Add what the sample leaves out, then rerun the payment and the 1.25x test. Land or build-out rent, pre-opening payroll, marketing and living costs. If coverage fails, change the plan before you sign.
You can do a first pass in the cost estimator in a few minutes.
Why will your number differ?
Market. Construction costs vary widely by region. JLL's 2026 outpatient fit-out benchmark notes that Northeast markets price higher than Sunbelt markets [8]. A single national rate cannot see your city.
Second-generation space. A suite that was already a dental or medical office may have plumbing, a mechanical room and walls you can reuse. On the right suite that takes a real bite out of construction. On the wrong one, demolition eats the savings.
Operatory count. Every op you add or drop moves equipment, space and construction together, as the comparison table shows.
Equipment choices. Premium versus standard chairs and delivery is a $16,000 per op swing in the model, and CBCT is a $70,000 swing on imaging. Dealer packages bundle choices you may not need on day one.
Tenant improvement allowance. In a lease, the landlord may fund part of the finish-out, which lowers what you borrow. How much varies by market and building; see negotiating the TI allowance.
This is the work I do in the Budget Plan: your op count, your market's construction costs, line-item equipment and imaging, and the coverage test, built before you sign anything. It is a flat $7,500 to $10,000, with scope set in writing. I am not a contractor, architect, lender or attorney, and I take no commissions from any of them.
Sample dental startup budget FAQ
What is a realistic budget for a 4-operatory dental startup?
In the Alithos planning model, a 4-operatory startup in leased space at standard finish comes to about $784,800 all-in, with a planning range of $746K to $824K. That includes construction, equipment, sensors and a pano, cabinetry, IT and furniture, soft costs and $85,000 of working capital. It is planning math, not a quote.
How much more does a premium finish with CBCT add?
On a 6-operatory leased office, moving from standard finish with sensors and a pano to premium finish with CBCT raises the model total from about $1,019,980 to $1,350,680, an increase of $330,700. Higher construction cost, premium equipment at $58,000 per operatory and the $130,000 imaging package drive the jump.
Why does a ground-up build cost so much more than a lease?
The model prices ground-up construction at $340 per square foot standard versus $170 in leased space, because you are paying for the building shell as well as the dental finish-out. Cabinetry and soft costs scale with construction, so on 2,700 square feet the gap is about $560,000 before land.
Is working capital part of the startup budget?
Yes. It should be. All three sample budgets carry $85,000 of working capital, the Alithos estimator's default, to cover payroll, rent and supplies while collections catch up with production. Your real number depends on your overhead and your ramp, so it belongs in the plan you take to the lender, not in whatever is left over.
Is there a free dental startup budget checklist?
Yes. Enter your email in the startup cost checklist form on this page and Dan emails you a one-page checklist of every line a dental office budget needs, including the costs these sample budgets leave out. It is one email, not a drip campaign.
How accurate are sample budgets?
They are accurate as arithmetic and approximate as predictions. The ranges are plus or minus 5% around a planning model, not quotes or survey data. Your market, your space, your operatory count and your equipment choices can move a real budget well outside them, which is why a sample is a starting point, not a plan.
Want these lines filled in with your numbers? Run the estimator for a first pass, then book a free Project Fit Call and we will go through your budget line by line.
How we research and update this page: every figure here comes from the Alithos planning model or a source listed below, and we recheck rates and published ranges when we update. Read our editorial policy.
Sources
- Alithos Advisory, 2026 dental office cost benchmark (planning model, not survey data) (2026). alithos.co/cost-benchmark
- ADA News, M. Jerkins, "Ask the Expert: How to be financially prepared for practice ownership" (2025). adanews.ada.org
- Dental & Medical Counsel, A. Oromchian, "A Dental Lawyer's Guide to Your Dental Office Build-Out" (2026). dmcounsel.com
- ADA News, M. Jerkins, "Ask the Expert: How much debt is too much when buying a dental practice?" (2026). adanews.ada.org
- Board of Governors of the Federal Reserve System, H.15 Selected Interest Rates (2026). federalreserve.gov
- U.S. Small Business Administration, 7(a) loan program: Terms, conditions, and eligibility (accessed 2026). sba.gov
- Starfield & Smith, "Best practices: equity injection requirements under SOP 50 10 8" (2025). starfieldsmith.com
- JLL, "Benchmarking the cost of fit-outs for today's outpatient care environment" (2026). jll.com
- Bank of America Practice Solutions, Dentist loans (accessed 2026). bankofamerica.com