I have a site with views in the millions, but no adsense. Adding any other ad delivery service creates a lot of spam and makes the website yuck. And the payout is orders of magnitude less than adsense. So i have just foregone ads and host on my own cost.
Getting into Adsense is becoming difficult and there are lots of horror stories of them randomly suspending accounts without payouts.
We switched away from ad networks ~5 years ago in favor of selling and hosting our own ads which are static jpg/pngs.
Our ads are matched against the content (office furniture ads on office design content) which still targets the reader in a roundabout way in that they will likely be interested in the ads if they are interested in the content.
There are several benefits including faster site, keeping 100% of the revenue, and getting to control the quality of ads to ensure a great experience for our readers.
We have also been removing 3rd party scripts (share buttons, etc) over the last year or so and only have Google Analytics and a Google Font left. The site still works if you block them.