• Purée tomatoes in a food processor until mostly smooth; there should still be some dime-sized pieces remaining. Set aside.

Meatballs

• Whisk panko, cheese, oregano, garlic powder, ¼ tsp. red pepper flakes, and 1½ tsp. salt in a medium bowl.
• Whisk in egg and cream.
• Add beef and mix with your hands until just combined, being careful not to overwork (if packed too firmly, meatballs will be dense).
• Form into 1"-diameter balls (you should have about 24); transfer to a plate.
• Heat oil in a large skillet, preferably cast iron, over medium-high.
• Cook meatballs, turning occasionally until lightly browned on all sides but not fully cooked through, about 5 minutes. Transfer to another plate.

Sauce

• Cook onion and garlic in the same skillet, stirring occasionally until onion is translucent and begins to soften, about 5 minutes.
• Season with salt and pepper.
• Add tomato paste and cook until brick red, about 1 minute.
• Add paprika and a pinch of red pepper flakes and cook until fragrant, about 1 minute.
• Add sugar, basil, and reserved tomato purée. Reduce heat and simmer until sauce is slightly reduced and flavors have melded, about 20 minutes.
• Add meatballs and any accumulated juices; continue to cook until meatballs are cooked through, 5–10 minutes.
• Stir in ½ cup of heavy cream and the grated Parmesan cheese.

Pasta & Assembly

• Meanwhile, cook pasta in a large pot of boiling salted water, stirring occasionally, until al dense.
• Drain and return to pasta pot.
• Pour sauce and meatballs over pasta and stir to combine.
• Transfer to a platter and top with cheese.