a <- data.frame(id=c(1,2,2,2,3),icd9=c("0781","00840","8660","7100","25011"))
sub('^(\\d{3})(\\d)', '\\1.\\2', a$icd9)
# => [1] "078.1" "008.40" "866.0" "710.0" "250.11"
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