Yes, I only use 6 action buttons. Most of them have at least two actions, using modifier-aware macros, and there is a second page I can switch to with Shift+Mousewheel. Everything else is keybound or on OPie. My shaman does have a second 4-button bar with totem flyouts, though someday I'll stop being so lazy and put them in OPie.
For example, button 5 in my screenshot is a macro like this (may not be exact because I'm at work and typing from memory):
/cast [mod:ctrl] [btn:4] Maim; [mod:alt] [btn:3] Savage Roar; [mod:shift] [btn:2] Ferocious Bite; Rip
There's a second bar in that screenshot because I haven't played my druid since Wrath and haven't figured out how I want to keybind those abilities yet, so for now I'm just clicking on them (I know, I know). The pet bar appears in the same space, so if my druid gets a temporary pet for a quest or something it's going to be kind of awkward.
Actually, it just occurred to me that I don't have a second page in Cat Form, so I can just put the things from that second bar on there. Problem solved!