The below code snippet shows annotating the spot elevation with the X and Y coordinates. Also changes the text style and the DGN file settings.

//Required References
using System;
using System.Diagnostics;
using Bentley.CifNET.GeometryModel.SDK;
using Bentley.CifNET.SDK;
using Bentley.DgnPlatformNET;
using Bentley.GeometryNET;
using Bentley.MstnPlatformNET;
using Bentley.TerrainModelNET;

public void AnnotateSpotElevationAndChangeSettings()
        {
            try
            {
                //The point for adding annotations
                DPoint3d spot = new DPoint3d(701862.5351088, 231737.762076, 0);

                //Get active DGN file
                Bentley.DgnPlatformNET.DgnFile dgnFile = Session.Instance.GetActiveDgnFile();
                //Get active dgn model
                Bentley.DgnPlatformNET.DgnModel dgnModel = Session.Instance.GetActiveDgnModel();
                //Create connection to dgnModel
                Bentley.CifNET.SDK.ConsensusConnection consensusConnection = new ConsensusConnection(dgnModel);

                //Get or create text style
                string textStyleName = "Line Length Label";
                DgnTextStyle textStyle = DgnTextStyle.GetByName(textStyleName, dgnFile);
                if (null == textStyle)
                {
                    double dWidth = 0.00270;
                    double dHeight = 0.00270;
                    double dLineSpacing = 0.70;
                    string fontName = "Arial";

                    //Change textstyle
                    textStyle = new DgnTextStyle(textStyleName, dgnFile);
                    DgnFont dgnFont = dgnFile.GetDgnFontMap().FindFontByName(out uint foundNum, fontName, DgnFontFilterFlags.All);
                    textStyle.SetFontProperty(TextStyleProperty.Font, dgnFont);
                    textStyle.SetProperty(TextStyleProperty.Height, dHeight);
                    textStyle.SetProperty(TextStyleProperty.Width, dWidth);
                    textStyle.SetProperty(TextStyleProperty.LineSpacing, dLineSpacing);
                    textStyle.Add(dgnFile);

                    //Change settings
                    Settings.TextWidth = dWidth;
                    Settings.TextHeight = dHeight;
                    Settings.LineSpacing = dLineSpacing;
                    Settings.Font = fontName;
                    Settings.TextStyleName = textStyleName;
                    Settings.TextJustification = TextElementJustification.CenterMiddle;
                    dgnModel.SaveModelSettings();
                }

                //Get active geometric model
                Bentley.CifNET.GeometryModel.SDK.GeometricModel geometricModel = consensusConnection.GetActiveGeometricModel();
                if (geometricModel.ActiveSurface == null) return;

                //Get active terrain
                Bentley.CifNET.GeometryModel.SDK.TerrainSurface terrainSurface = geometricModel.ActiveSurface as TerrainSurface;
                if (terrainSurface == null) return;

                DTM dtm = terrainSurface.DTM;
                Bentley.TerrainModelNET.DTMDrapedPoint drappedPoint = dtm.DrapePoint(spot);
                if (null == drappedPoint || (int)Bentley.TerrainModelNET.DTMDrapedPointCode.External == drappedPoint.Code)
                    return;


                double xCoord = drappedPoint.Coordinates.X;
                double YCoord = drappedPoint.Coordinates.Y;
                double elevation = drappedPoint.Coordinates.Z;

                string xCoordStr = xCoord.ToString("N2");
                string YCoordStr = YCoord.ToString("N2");
                string elevationStr = elevation.ToString("N2");

                string text = xCoordStr + "," + YCoordStr + "," + "Elevation =" + elevationStr;

                //create annotation and add to model
                TextBlock textBlock = new TextBlock(textStyle, dgnModel);
                textBlock.AppendText(text);
                textBlock.SetUserOrigin(spot);
                Bentley.DgnPlatformNET.Elements.TextElement textElementCtr = (Bentley.DgnPlatformNET.Elements.TextElement)Bentley.DgnPlatformNET.Elements.TextElement.CreateElement(null, textBlock);
                textElementCtr.AddToModel();
            }
            catch (Exception ex)
            {
                Trace.WriteLine(ex.Message);
            }
        }

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