One of the best things to have happened to NYC is the requirement of the display of sanitary grades. I consider myself to be a grade snob, and you will have a very hard time convincing me to eat at a place that is ranked anything other than an "A."
(I tell my friends that I won't eat from a food truck because they don't receive sanitary inspection grades, but it's really just because I don't want to eat food that's been saturated by NYC's air pollution.)
I have been known to eat at an occasional "B" restaurant, but only in the cases in which I've eaten at the restaurant in the past - and loved it - and can't resist going back. But, if it's a new place, and it's between dining at an A-rated McDonald's or a B-rated gourmet pizza place, I'd be inclined to choose McDonald's. Most likely.
"B" restaurants can get by if they cleverly abscond their letter or just serve high quality food that is too yummy to resist.
What I don't understand, however, is how "C" restaurants can still open their doors. I learned (after researching on the internet) that restaurants have the choice to display their grade or "Grade Pending" if anything other than an "A" is received. This means that a handful of restaurants - although admittedly, I've only seen a few in Manhattan - have the cojones to display their "C." Perhaps the "C" actually stands for cojones.
More likely, however, it means that you should avoid these restaurants at all costs.
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