Hi @Jeff B ,
I'm glad that you were able to resolve your issue and thank you for posting your solution so that others experiencing the same thing can easily reference this! Since the Microsoft Q&A community has a policy that "The question author cannot accept their own answer. They can only accept answers by others ", I'll repost your solution in case you'd like to "Accept " the answer.
Issue:
You granted admin consent for the organization in the API Permissions in the App Registration, but users still received the "Approval Required" notification. The request did not show up in "Pending", and even though you repeatedly approved them, the requests kept coming and the prompts kept reappearing. All requests showed up as having an "Approved" status.
Solution:
Under the App registration > [app name] > API permissions you added the Dynamics 365 Business Central "user_impersonation" permission which allows users to impersonate their user account.
If you have any other questions or are running into more admin consent issues, please let me know. I had also surfaced your issue with the product team to get clarity around the permission requirements so that we can update the documentation.
Thank you again for your time and patience throughout this issue.
Please remember to "Accept Answer" if any answer/reply helped, so that others in the community facing similar issues can easily find the solution.