Keck Medicine of USC dental plan

The USC Verdugo Hills dental insurance plan is administered by Delta Dental.

BENEFITIn-network (Delta Dental provider)Out-of-network
Deductible Individual / family
$50 / $150

$50 / $150
Maximum
$1500 per person per calendar year (maximum payments to an out-of-network provider: $1000)

$1500 per person per calendar year (maximum payments to an out-of-network provider: $1000)
Waiting periodsNoneNone
Diagnostic and preventive services
• Routine oral exams
• Cleaning / scaling
• Bite-wing and full-mouth X-rays
• Space maintainers
• Fluoride treatment
100% (deductible waived)80% of the lesser of the fee actually charged, or the fee that satisfies the majority of Delta Dental dentists (deductible waived)
Basic services
• Oral surgery
• Extractions
• Endodontics
• Periodontics
• Sealants (for children under age 16)
• Anesthesia
80%80% of the lesser of the fee actually charged, or the fee that satisfies the majority of Delta Dental dentists
Major services
• Crowns
• Inlays, onlays, and cast restorations
• Bridges and dentures
50%
50% of the lesser of the fee actually charged, or the fee that satisfies the majority of Delta Dental dentists
Implant benefits50%50%
Implant maximums$1,500 Calendar Year$1,500 Calendar Year
Orthodontic benefits (adults and children)50%50%
Orthodontic lifetime maximum$1500 per person$1500 per person

Delta Dental | www.deltadentalins.com

(800) 765-6003