Dental payroll · September 20, 2026
Best payroll software for dentists (2026)
Hygienists, front desk, and a payday that files. A practice OS is not a substitute for tax deposits.
By Gregory GreensteinUpdated September 20, 2026Affiliate disclosure
Dental payroll is still US payroll: W-2s, withholdings, deposits, and a Friday that does not bounce. The extra jobs are mixed hygienist/assistant/front-desk schedules, associate compensation that is not a simple hourly, and a practice manager who will not finish a hospital HCM. Dentrix-class clinical software is a different product. We will not rank it as payday.
This ranking is for US independents and small groups — one to a few operatories — not a DSO rollup. Gusto publishes a bill a manager can put on a napkin. Square wins when the front desk already takes cards and bookings on Square. Paychex and ADP are quotes for offices whose CPA or 401(k) already lives there.
Healthcare-practice payroll is the sibling if you are medical, PT, or medspa rather than dental. Salon payroll is the sibling if you are chairs and tips. Do not buy a dental-specific HRIS because a consultant said “compliance.” The compliance is tax deposits and classification.
Prices as of September 21, 2026. Classification of associates, specialists, and 1099 temps is a legal question. This is not wage, benefits, or HIPAA advice. We are not your accountant.
The short list
Public list prices as of September 20, 2026. Promos change. Confirm on the vendor page before you buy.
| # | Product | Best for | Public starting price | Score |
|---|---|---|---|---|
| 1 | Gusto | Practices that want published pricing and a manager who can finish setup without an EHR lock-in | Simple $49/mo + $6/person; Plus $80 + $12; Premium $180 + $22. Contractor Only $35 + $6. Simple is single-state. | 8.5 |
| 2 | Square Payroll | Offices already taking cards and bookings on Square Appointments | Full-service $35/mo + $6 per person paid that month. Contractor-only $6 per contractor paid, no base fee. | 8.2 |
| 3 | Paychex Flex | Offices whose CPA, 401(k), or workers’ comp already lives at Paychex | Quote-only. Packages are typically Flex Select, Pro, and Enterprise. Request PEPM, base, implementation, year-end, and benefits add-ons in writing. | 7.6 |
| 4 | ADP RUN | Practices whose lender or CPA already standardized on ADP | Quote-only. Packages are Essential, Enhanced, Complete, and HR Pro. ADP asks you to request pricing. | 7.5 |
01
Gusto
Practices that want published pricing and a manager who can finish setup without an EHR lock-in
Public pricing: Simple $49/mo + $6/person; Plus $80 + $12; Premium $180 + $22. Contractor Only $35 + $6. Simple is single-state.
Gusto public pricing (gusto.com/product/pricing), reviewed September 21, 2026.
Skip if
Your CPA or benefits broker already lives in Paychex or ADP and will not switch. Or the front desk already lives in Square and hours come off that login.
Why it ranks
- A practice manager can estimate eight W-2s on a napkin — rare in dental vendor decks.
- Full-service US filings, with 1099s if temps are contractors. Classification is still on you.
- Benefits sit next to payday when the first benefits-eligible associate appears.
- Pairs with QBO and Xero, where many practice books already live.
Watch-outs
- Simple is single-state. A second office in another state usually means Plus.
- Not Dentrix. Clinical and payday should stay separate unless someone will actually run both.
- PTO and on-call still have to be configured. Software files what you set up.
- Do not buy Premium for a three-operatory shop to look like a DSO.
02
Square Payroll
Offices already taking cards and bookings on Square Appointments
Public pricing: Full-service $35/mo + $6 per person paid that month. Contractor-only $6 per contractor paid, no base fee.
Square Payroll pricing (squareup.com/us/en/payroll/pricing), reviewed September 21, 2026.
Skip if
You are not on Square and do not plan to be. Payroll alone is cheaper to compare against Gusto without dragging in a new front-desk stack.
Why it ranks
- Hours can come from Square Team / Appointments instead of a third timesheet.
- Published math you can put next to Gusto — $35 + $6 vs $49 + $6.
- Same login family as the front-desk card. That is the whole reason it ranks here.
- Contractor-only is honest if temps are 1099s — still a classification question.
Watch-outs
- Per-person fees apply in months you pay them. Seasonal assistants still show up.
- Multi-state and multi-EIN limits exist. Read Square’s current constraints.
- Benefits are partner add-ons, not the $35.
- If the practice OS already includes payroll, do not dual-stack Square for a $14 base-fee delta.
03
Paychex Flex
Offices whose CPA, 401(k), or workers’ comp already lives at Paychex
Public pricing: Quote-only. Packages are typically Flex Select, Pro, and Enterprise. Request PEPM, base, implementation, year-end, and benefits add-ons in writing.
Paychex official site (paychex.com), reviewed September 21, 2026. No national self-serve rate card.
Skip if
You want a napkin bill this Tuesday. Paychex is a conversation. Start with Gusto unless the relationship is the product.
Why it ranks
- The relationship is the product: retirement, workers’ comp, a local-ish contact.
- Useful when the broker will not move the 401(k) the associates already sit on.
- Full-service filings on standard small-business packages they advertise.
- See Paychex vs ADP and Gusto vs Paychex if you are arguing in a partner meeting.
Watch-outs
- You cannot compare Flex to Gusto Simple without a quote.
- Implementation and year-two fees are how teasers happen.
- Not an EHR and not a scheduling OS.
- We do not treat third-party call quotes as list.
04
ADP RUN
Practices whose lender or CPA already standardized on ADP
Public pricing: Quote-only. Packages are Essential, Enhanced, Complete, and HR Pro. ADP asks you to request pricing.
ADP RUN pages, reviewed September 21, 2026.
Skip if
You do not have a written quote. Brand is not a rate card.
Why it ranks
- Boards, lenders, and some DSOs already know the logo.
- A path into broader HCM if the group actually grows past a few chairs.
- Filings and garnishments are why the brand exists.
- See Gusto vs ADP RUN for the published fork.
Watch-outs
- No napkin. No comparison.
- Implementation is a project a three-chair office often regrets.
- Do not buy RUN to look like a hospital system.
- Rippling is the IT fork — see Gusto vs Rippling payroll — not a dental default.
How we picked
The job is US dental payday: mixed staff, filings, and a manager who can finish setup. We scored published pricing honesty, Square adjacency, and quote friction. Practice-management suites stay off unless payroll is a first-class published product. AI scribes and charting tools stay on Aiacent.
Eight W-2s, one state, on September 21, 2026 list prices: Square Payroll is $35 + $48 = $83 if you already have Square and pay all eight that month. Gusto Simple is $49 + $48 = $97. Paychex and ADP require quotes that include implementation. That napkin is the whole method. If a vendor will not beat $97 in writing after year-two fees, you do not have a reason to leave Gusto.
Who should skip this page
- Medical, PT, or medspa — use healthcare-practice payroll. The skip-ifs differ.
- A DSO shopping an enterprise HCM. This page is independents.
- A solo dentist with no W-2s yet. Open a business account and a ledger first. See freelancer banking.
- Anyone buying “AI that does payroll.” That catalog is not Incacent.