Dentists run businesses that look more like retail than the rest of healthcare. Patient pay is a meaningful share of revenue. Insurance reimbursement matters but doesn't dominate. Membership plans and financing platforms are part of the mix. CDT codes are not E&M codes. Banking that gets dental gets these realities.

Most banks don't.

This piece walks through what dental practices actually need from a bank, how the major options stack up, and what to look for when you're picking.

What a Dental Practice Actually Needs From a Bank

Six things, in rough order of impact on cash flow.

Insurance reconciliation that handles dental claims. Delta Dental, Cigna Dental, MetLife, Aetna, Guardian, regional Blues. ERA 835 files for dental are structurally similar to medical, but the codes and adjustments are different. Your bank should match payments to claims automatically.

A medical lockbox priced for dental. A meaningful share of dental insurance still pays by paper check. If you're depositing 50 to 200 paper checks a month, you need a lockbox that doesn't cost more than the time it saves.

Multi-location support. DSOs are now common, and even single-owner practices often run 2 to 4 locations with a holding company. Your bank should onboard new entities in days, not quarters.

Free ACH and reasonable wires. Dental practices send a lot of small ACH (vendor payments, lab fees, contractor 1099s). Per-transaction fees add up.

Yield on operating cash. Most dental practices keep $200K to $1M in working cash. At 0% APY that's a real opportunity cost.

A clean dashboard. Membership revenue, financing platform settlements, insurance, and patient pay should show up separately. You can't manage what you can't see.

How the Major Options Compare

Bank of America, Chase, Wells Fargo bring branches, scale, and mature wire desks. They bring zero healthcare-native features. ACH fees, 0% APY on operating, slow onboarding for additional entities.

Live Oak Bank is excellent for SBA loans. Operating layer is generic. Best used as a lender plus a separate operating bank.

Mercury, Bluevine, Relay are modern fintech banks. Clean dashboards, free ACH, decent yield. None of them speak ERA 835 or run a medical lockbox.

Lemma is healthcare-native. ERA 835 matching, medical lockbox at $2.50 per check, multi-entity onboarding in 5 to 10 days, 1.75% APY across the structure, $10M FDIC per entity through IntraFi.

What to Pick

If you're a single-doctor practice doing $500K to $1M, mostly insurance and patient pay, and you want one platform that handles deposits, reconciliation, and yield without bolt-ons: Lemma fits.

If you're a 3-to-5 location DSO or DPO running on a holding company plus operating PCs: Lemma is built for this. Each PC gets its own FDIC entity, the parent gets consolidated reporting.

If you have a Live Oak SBA loan: keep it. Bring Lemma in for operations.

If your practice is cash-pay only and under $250K cash on hand: a fintech like Mercury or Relay can cover it. The reconciliation pain hasn't shown up yet.

The $2M Practice Math

Two locations, $2M annual collections, $300K operating cash, 200 ERA files monthly, 80 paper checks monthly.

On a generalist bank: ~$1,200/year in ACH fees, 0% on operating cash, ~25 hours/month of manual ERA matching ($10,500/year fully loaded), separate lockbox vendor at $4,800/year minimum. Net annual cost: roughly $16,500.

On Lemma: $0 ACH fees, 1.75% APY on $300K ($5,250/year of yield), automated ERA matching, included lockbox. Net annual benefit: roughly $20,000 versus the generalist baseline.

What to Ask Any Bank Before Switching

Do you ingest ERA 835 files? At what cost?

What's your medical lockbox per-check fee? Any monthly minimum?

How long does it take to onboard a second PC under our holding company?

What's the FDIC ceiling per entity?

What's the APY on operating cash, not just on the swept savings balance?

If any answer is "we don't do that" or "60 to 90 days," you're being asked to subsidize a generalist bank's lack of healthcare specialization.