Routine dental X-rays are not backed by evidence

What actually positively surprises me is that the American Dental Association publishes recommendations that are to the financial disadvantage of almost all its members.

These panoramic X-rays are typically performed by technicians/adjunct personnel. So I would guess that dentists don't directly pocket the money from them, or willingly recommend them.

A more likely scenario is that dentists are employed by a dental clinic (even if you see the same dentist every time). The dental clinic wants to maximize profit for shareholders, so they invented the "routine dental X-ray" guideline. The guideline is then imposed on the destists as a "performance quota". E.g. if you have 300 patients assigned to you, you are expected to prescribe at least 150 panoramic X-rays to you patient pool. Drop below the quota, and there goes your performance bonus, which you may otherwise be totally worth of.

Of course, there will also be cases where the dental clinic is owned by a single greedy dentist.