My dentist's office actually has a computer screen in front of the patient, and when they schedule follow up visits, I can clearly see the Outlook calendar, with each patient's name and a DOLLAR amount next to the name. That's the OOP goal for each sucker.
My parents did not provide me with dental care from 6-16 years of age. Not b/c of finances, they are immigrants and when the Italian dentist they knew retired, they simply couldn't find another one for a decade. Luckily, other than a few cavities, my teeth were OK, so I got routine care for a few years, and then didn't make it a priority until my mid 30's. Again, fairly lucky, some cavities, a small inlay, and pulling my upper molars b/c my impacted wisdom teeth were pushing down and caused a pocket where tooth decay occurred. From this point forward, I go 2X/year, same office, everything's great. Until three years ago, when the dentist walks in w/a stern look, and informs me that the gum loss on an upper front tooth is severe and will need a periodontist to review and operate. I mean, I could see that the gumline was higher, but it's always been that way, and the tooth is SLIGHTLY crooked, but no one said anything for over seven years! I casually ask if perhaps an implant makes more sense, and I can actually see the dollar signs in the dentist's eyes. When I learn that it's a several month process, without a noticeable tooth, AND will cost me $5K OOP after insurance, I was like, nope, let's save this tooth instead. It took them over a year to update my chart to remove the icon for the implant, just b/c I asked a question.
They have a perio on staff, so I make an appointment. She's all doom and gloom, and informs me that the odds are good that I will need to have 5-8 upper front teeth removed! By that point, I was done, so I told the office manager I was getting a second opinion. My insurance covered ONE perio office in the area, who luckily had great reviews. His office is completely different, and we talk about options, he explains that I will need to do something, but it's not anywhere near as dire as they told me, and it's also not incredibly urgent. (Open enrollment at work was coming up, so I wanted to wait and see if it would make sense to get better dental coverage prior to the surgery.)
Long story short, he recommends a deep cleaning ($175 OOP), which helps a lot, but we ultimately do the surgery 6 months later ($1,350 OOP), followed by quarterly cleanings ($90 OOP) at his office. The cleanings cost more there, but they teach me how to properly brush my teeth, show me some tools I didn't know about, and those cleanings were 45 minutes of actual cleaning like I've never had done before - she offers topical numbing each time, and you actually do want that, she goes to town! My gums are amazing now, the damage has been mitigated with excellent success. :)
However, I am required to go see my dentist once/year, mostly so he can bill insurance for another round of X-rays. Then he comes in, pushes down on my teeth like he's trying to break them, shakes his head and tells me how it's a miracle that my teeth and gums are so healthy now, and then tries to suggest that implant or braces for that slightly crooked tooth. I give him a blank look, then ask "cosmetic?" He says yes, and I say I'm fine with how my teeth look. He shakes his head and leaves. We do this every damn year. The only reason I don't switch is b/c my insurance pretty much only pays for those chain places, and my experience w/those has been far worse.