Fort Worth and Uptown should never share an ad group
The two anchor cities are far enough apart to behave as separate markets, and no single bid is correct for both.
Dallas and Fort Worth are distinct markets with distinct downtowns, competitor sets and prices. A campaign covering both averages two markets into one number and then optimizes toward the average, which serves neither.
Radius targeting compounds the error. A circle drawn around a Southlake or Grapevine office crosses Tarrant, Denton and Dallas counties before it finishes. Target by city and ZIP instead, chosen from where your current patients actually live.
Pull those addresses out of the practice software. You will usually find the real service area is smaller and lumpier than the map you have been buying, with a long tail of one-off patients you should not pay to repeat.
Set location targeting to people present in your chosen areas rather than people showing interest in them. Otherwise you buy clicks from someone in another state reading about dentists in Dallas.
Then name the exclusions out loud. Deciding you will not serve Denton County is a budget decision, and making it on purpose is cheaper than discovering it in the search terms report.