Azure SQL Databases hit cpu limits too quickly
For questions like these you need to include the query plan and relevant table structure (what keys and indexes are in place) to get a good answer that is specifically relevant. I recommend that you update the question with that detail.

The first thing that springs to mind is the JOIN to Answer - is there a useful index for the QuestionId column that you are joining on? A common error is to assume that defining a foreign key constraint also defines an index (much like defining a unique constraint does) but this is not the case. Most RDBMSs don't because there are occasions where the index is not needed at all so creating one implicitly would be wasteful of space and unnecessarily add I/O to insert &amp; update operations.

If there is no useful index on Answer.QuestionId then that table will be subject to a scan (and probably a sort too) which if the table is small enough to fit in memory will generally be a CPU-bound operation.

If you are seeing this a lot in your DB with the same pattern of query then it may be that your DB devs are working under the assumption that adding a foreign key also defines an index, possibly because they have a mySQL background as IIRC that does create an index implicitly when an FK is defined.