TopsOrtho is a practice management system designed specifically for orthodontists. It’s a powerful software that supports everything from appointment scheduling to staff management, treatment planning, payment acceptance, and more.
Whether you’re currently using TopsOrtho and TopsPay or you’re a prospective customer who wants to learn more, this review will help you get the best possible deal.
You’ll get our insider take on TopsOrtho’s payment processing options, plus more insights on the software’s pros, cons, and pricing.
Our Insider Take on TopsOrtho
One standout feature of TopsOrtho is its integrated payment processing capabilities, which allows orthodontic practices to manage payments directly within the platform.
There are two ways to set this up—either using TopsPay (the in-house processing solution from TopsOrtho) or integrating with Fiserv (a third-party processor).
Regardless of which processor you use, we find that most orthodontic practices using TopsOrtho end up overpaying on payment processing for a variety of reasons. Fortunately, there are several ways that you can save money here while continuing to use TopsOrtho uninterrupted (and you won’t have to change processors, either).
Pros
- Cloud-based hosting makes it easier to deploy and manage.
- Interchange-plus pricing is available.
- Solid features to support your basic practice management needs.
Cons
- Limited features compared to other practice management systems.
- Only two options for integrated payment processing, which drives up costs.
- Tops TotalPackage is basically an excuse to charge extra fees for hardware leases.
- TopsPay Premier adds costs for features that should be included in the base TopsPay offering.
Overall, TopsOrtho is an average practice management software. It’s not quite as popular as some of the industry leaders in this space. And while the features are decent and the software works as advertised, I don’t love the fact that you have to pay more to access features that don’t warrant premium price tags.
TopsOrtho Overview and Key Features
TopsOrtho is built for Apple products, designed explicitly for Mac computers, laptops, and iPads. Even though it’s supported through cloud hosting (meaning you don’t have to maintain your own servers), the software runs natively on your Mac hardware.
The product is offered as five different solutions:
- Tops — Basic practice management features.
- TopsDPX — Includes HIPAA-compliant patient messaging tools.
- TopsPay — Integrated payment processing.
- TopsPay Premier — Processing with account management extras.
- Tops TotalPackage — Includes Apple hardware.
But here’s the thing. This is all just a marketing ploy.
The base TopsOrtho product covers stuff like patient scheduling, iPad check-ins, and the ability to e-file insurance claims. If you want features like two-way texting with patients and automated appointment reminders, you’ll need to upgrade to TopsDPX.
On the payments side, TopsPay Premier advertises enhanced features that don’t really justify any extra cost. And Tops TotalPackage is just a way for TopsOrtho to charge you for hardware.
Other practice management systems for orthodontists include more features under a single plan. With TopsOrtho, you’ll need to integrate third-party solutions for things like analytics, online intake forms, lab management, and patient education.
Key Features
- Contract creation
- Insurance billing with claims tracking
- Appointment reminders
- One-touch patient check-ins
- Imaging integration
- Custom patient scheduling templates
- HIPAA-compliant two-way texting
- Personalized treatment planning
- PCI-compliant payment processing
TopsOrtho Integrated Payment Processing Options
The ability to accept card payments directly within your practice management is a huge advantage for orthodontists. If you’re using TopsOrtho, there are two main ways to set this up.
You can either use TopsOrtho’s in-house payment solutions (TopsPay or TopsPay Premier) or integrate directly with Fiserv.
Let’s walk through all of these options so you can figure out what’s best for your practice.
TopsPay
Anytime you’re using a software’s own branded payment solution, you need to realize that they’re using a third-party provider to power everything on the backend. This is important for several reasons.
First, your TopsOrtho sales rep is obviously going to push the platform’s in-house payment solution (TopsPay) over other options because it’s more money for the company.
There’s nothing inherently wrong with TopsPay. But you just need to be aware that your rates will always be slightly more inflated here because of the backend arrangement.
Overall, TopsPay allows you to accept one-time card payments, ACH payments, insurance credit cards, and set up auto-pay plans. It’s solid.
TopsPay Premier
TopsPay Premier is advertised as “payment management with premium perks.” But I don’t see any reason for you to pay for this.
One of these “perks” is proactive card monitoring. On the regular TopsPay solution, you’ll be shown upcoming card expiration dates in advance. But with Premier, they’ll flag expired cards to ensure the auto-pay keeps running smoothly even when cards expire.
But this is just an account updater service that’s a pretty standard offer across all major card networks now. Visa Account Updater, Mastercard Automatic Billing Updater, Amex Account Update Service—all of these let businesses process cards on file with expired cards by updating them automatically.
Fees typically range from $0.05 to $0.25 per successful update, and payment processors normally pass-through the fee at cost without markup. So TopsPay calling this a “premier” service is pushing it.
What you’re really paying for here is the collection service. If a transaction declines, TopsPay triggers an automatic follow-up, which includes a phone call, email, and bi-weekly outreach for up to 90 days.
Again, I don’t really think this is worth an added cost. You could see these declined reports on your own and have your staff handle the follow-up instead of sending out automated emails from Tops.
Fiserv
Fiserv is a traditional payment processor. Other than the supported integration, Fiserv is completely independent of everything else you’re doing with TopsOrtho.
What I mean by this is that TopsOrtho won’t have anything to do with setting your rates or handling your payments if you’re using Fiserv.
Your software subscription for the practice management tool and the payment processing capability are two different solutions, but delivered under one roof through an integration.
The upside of using Fiserv over TopsPay is that you’re going straight to the processor (instead of TopsPay using a backend processor and branding it as their own). So theoretically, you should be getting access to better rates this way.
Shoot for no more than a 50 basis point markup here. While 50 basis points is higher than we’d recommend paying for regular processing, it’s not awful for an integration.
Fiserv is actually a pretty decent processor and they’re very transparent.
Rate increases aren’t as frequent as other processors (although Fiserv did raise rates in 2025).
Learn More: Fiserv Review | Fiserv Rates
TopsOrtho Alternatives
If you’re not quite sold on TopsOrtho or TopsPay for your orthodontic practice, there are plenty of other options on the market to consider.
Here are some popular TopsOrtho alternatives that all support integrated payment processing:
- OrthoFi — Integrates with Stripe, Breeze, and part of OrthoBanc. Full review here.
- Dolphin Practice Management — Integrates with Global Payments, Breeze, and Rectangle Health. Full review here.
- Cloud 9 (Planet DDS) — Integrates with Global Payments, Worldpay, and Planet DDS Pay. Full review here.
- WaveOrtho — Integrates with TSYS and Fiserv. Full review here.
- Orthotrac (Carestream) — Integrates with TSYS and Global Payments. Full Review here.
To be clear, we have zero affiliation with these solutions. So use whatever works best for your practice. All we want to do is provide you with the information based on our experience with our clients using these tools, and we’re not trying to sway you in one direction or the other.
If You’re Already Using TopsOrtho, Consider This Instead of Switching
We don’t recommend switching away from TopsOrtho because you’re unhappy with your payment processing rates.
If the software itself isn’t delivering, that’s another story. But on the payment processing side, there’s plenty of room for negotiation directly with TopsPay or Fiserv to get a better deal.
We have extensive experience helping orthodontic and dental practices negotiate better payment processing rates directly with their current providers.
It doesn’t matter what software you’re using or who is handling the payments on the backend, our team can help you save thousands every month without changing anything. Contact us for a free audit to learn more.
Final Thoughts on TopsOrtho and its Integrated Processing For Orthodontists
TopsOrtho is a fairly basic orthodontic practice management solution. It has the essentials, but you need to integrate with other solutions for additional capabilities.
So if you’re looking for a true “all-in-one” solution, this probably isn’t it. But it’s solid for the basics, and you can set up integrated processing fairly easily.
My biggest gripe with TopsOrtho and TopsPay is that they market their tools (like TopsPay Premier and Tops TotalPackage) as items worth a premium markup. But you’re not really getting enough from either of these to justify the added cost.
TopsPay Premier basically just automates the way you manage expired and declined cards. And Tops TotalPackage is a way to “get new Apple hardware every three years,” which can be translated to higher fees for upgrades you don’t actually need.
With all of that said, TopsPay and Fiserv are both fine for integrated processing within TopsOrtho. Just make sure to audit your statements to make sure you’re not paying over 50 basis points (0.50%) as a markup, and don’t let either provider charge you random, bogus monthly fees.
If you’re not sure whether you’re getting a good deal, let our team take a look at your statements to identify cost-saving opportunities.