Combine the ground beef, half the Parmesan, breadcrumbs, egg, garlic, salt, and pepper in a bowl. Mix just until combined to avoid tough meatballs. Shape into 1-inch balls and set aside.
Heat a pot over medium-high heat and add a drizzle of oil. Brown the meatballs on all sides until they develop a golden crust. Remove and set aside; they will finish cooking later in the sauce.
In the same pot, add the orzo and pour in the tomato basil sauce. Stir well and nestle the browned meatballs back into the mixture. Cover and let everything simmer until the orzo softens and the meatballs cook through.
Reduce heat and stir in the remaining Parmesan, shredded mozzarella, and cream. Add fresh basil, letting the cheese melt into a rich and velvety sauce. Adjust seasoning with salt and pepper.
Give everything a gentle final stir, making sure the orzo is coated and the sauce is creamy. Serve hot with extra basil and a sprinkle of Parmesan on top for a beautiful finish.