We use it on medium size tables (around ~100M rows and ~100GB each). No problems. The perf boost we get from clustering rows in the right spot on the disk is huge.
We do have fragmentation within a block. Our records on the heap are about 150 bytes, so maybe 30 rows per 4K page. In the pathological case where there is 1 row per page due to fragmentation, queries have to fetch 30x the number of blocks, which is a killer on a spinny disk.